Balance My World Pilates ParQ
If you are between the ages of 16 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.
Please read the following questions and answer each one honestly.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Required
Do you feel pain in your chest when you do physical activity? *
Required
In the past month, have you had chest pain while you were not doing physical activity? *
Required
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Required
Do you have bone or joint problems that could be made worse by physical activity? *
e.g. Spinal conditions such as herniated or prolapsed discs, spinal stenosis, spondylosis, scoliosis, osteoporosis, hip or knee replacement etc.
Required
If yes, please give details.
Your answer
Is your doctor currently prescribing drugs for blood pressure or heart condition? *
Required
Are you taking any medication? *
If yes, please give details
Your answer
Are you taking any medication? *
If yes, please give details
Your answer
Are you pregnant or recently had a baby? *
Required
Have you had any recent injuries or operations? *
If yes, please give details
Your answer
Do you know of any other reason why you should not do physical activity? *
Required
If yes, please give details
Your answer
If you answered YES to one or more questions, please talk to your doctor before you become more physically active or have a fitness appraisal. Discuss with your doctor whether Pilates is suitable.
If you answered NO to all the questions, you can be reasonably sure that you can start to become more physically active. Start slow and build up. However, delay becoming more active if you are not feeling well because of a temporary illness such as a cold or flu, or if you are or may be pregant. Talk to your doctor first.
I have read & understood and completed this questionnaire. Any questions I have answered to my full satisfaction. *
Required
Informed Consent for Participants
Pilates exercise programmes are designed to improve muscle tone and strength, endurance and flexibility and may include physical activities such as stretching, using weights and using equipment/machines.

When participating in activity/exercise you are likely to experience different levels of intensity over varying lengths of time. As a result you may experience quicker breathing patterns and become hot, as well as feelings of awkwardness depending on your experience or level of fitness.
Each part of the activity/exercise you participate in will be fully explained, you are strongly advised to ask questions if you are not clear about anything.

Most exercise programmes contain certain risks: muscles pulls, joint strains, aches, pains and general discomfort from parts of the body not previously used, and whilst every care will be taken to ensure your safety, it is impossible for another person to predict the body's response to the Pilates programme.

If at any time you feel any pain or discomfort, stop performing the activity and notify the instructor. Likewise, if you feel that you should not do a particular exercise for any reason, you must inform the instructor.

I have completed the ParQ above and have consulted with my GP if I answered YES to any of the questions above. My GP has agreed that I am fit to take part in a Pilates class. If I answered NO to all the questions above, I am happy to take part in a Pilates Class.

I have read and understood the conditions and risks of participation, and I consent to take part voluntarily in the activities required. It is hereby understood and agreed that "Balance My World Pilates" or its staff, accept no responsibility for accident, injury or illness, loss or misadventure caused to or suffered by me.

I am free to withdraw my consent from the activities at any time, without negative consequences.

I understand that relevant sections of any of my medical data collected during the activities may be looked at by other Instructors at Balance My World Pilates where it is relevant to my taking part in a session and I give permission for these individuals to have access to my records.

By ticking the I Agree box you consent to all the above.

*
Required
First Name *
Your answer
Surname *
Your answer
Email *
This will be used to keep you up to date with class schedules and to notify you of class cancellations. Please also include a mobile number if you would prefer to be texted in the unlikely event of a short notice class cancellation.
Your answer
Emergency contact Name & No. *
This will be used if for any reason we need to contact someone on your behalf during a class.
Your answer
Have you done Pilates before? *
Required
Please indicate which class you will be attending *
e.g. Monday 6.15
Your answer
Thank you!
Thank you for filling in this form. We look forward to seeing you in a class!
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