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Flow Dance & Yoga
We at Flow Dance & Yoga want to ensure that you enjoy and feel safe in our Dance and Yoga sessions. This PARQ (Physical Activity Readiness Questionnaire) is to inform us your teacher of any injury, condition or of any general concern that you may have when participating in one of our sessions.
This information is for the teachers reference only, and to ensure that we can deliver you personalised and appropriate classes.
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Email *
Name *
Date of Birth *
Email *
Contact Number *
Has your doctor ever told you that have a condition that may be aggravated by physical exercise? *
Do you have diabetes? *
Do you have high/low blood pressure (Please specify) *
Do you have a Heart Condition? *
Have you ever experience chest pain/unusual shortness of breath during physical activity? *
Do you experience fainting, dizziness or loss of consciousness during physical exercise? *
Are you, or is there any possibility that you might be pregnant? *
Have you had any major surgery in the past 12 months? *
Do you have an ongoing physical injury? *
Do you suffer from any allergies (outside classes bees, hayfever, carry an EPI Pen etc). *
Have you had any symptoms of COVID-19 in the past 14 days? *If you get symptoms of COVID-19 in the lead up to your class please notify Flow Dance & Yoga immediately. *
If you answered YES to any question please give more details below.  *IF you have answered YES to one or more questions, please consult your GP if you have not already done so. Ask your GP’s advice on your suitability for physical activity. *
Are you happy for Flow Dance & Yoga to contact you via Email? *
Emergency Contact Details: NAME / RELATIONSHIP / PHONE *
I hereby state that I have read and understood the questions above, and wish to participate in activities which include aerobic exercise resistance exercise and stretching. I acknowledge that by participating in physical activity there is possibility of injury. I confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me. (Please write your name) *
Date of completion *
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