PAR-Q form for Fit Beats/Clubbercise
General health questionnaire - Physical Activity Readiness - Questionnaire

Essential if you would like to attend a class: Fit Beats (St James Hall, Mondays 7-8pm) or Clubbercise (Malorees Junior Hall, Thursdays 4.30-5.30pm). 
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FIrstly is it Clubbercise or Fit Beats (or potentially both) you want to join? *

Q1. 

What is your Full Name and Date of Birth?

*

Q2. 

Please write your Phone no. and Email

*
Q3.

Has a doctor ever said you have heart trouble?

*

Q4.

Do you ever experience chest pain when you do physical activity?

*

Q5.

In the past month, have you had chest pain when you were not doing physical activity?

*

Q6.

Do you lose balance due to dizziness or have you lost consciousness?

*

Q7.

Do you have a joint or bone problem that could be made worse by physical activity?

*

Q8.

Is a doctor currently prescribing drugs for your blood pressure or heart condition? *

Q9.

Do you know of any other reason why you should not participate in physical activity?

*

Q10.

Disclaimer & Consent: If you answered “Yes” to one or more questions, consult with your doctor before continuing. If you answered “No” to all questions, you are likely able to engage in physical activity but should still consult with healthcare providers if you have concerns or experience discomfort.

·  I understand that this PAR-Q form is a self-assessment tool and does not replace medical advice. I affirm that the information provided is accurate, and I assume responsibility for my health and wellbeing. Please select this answer and type name below

·  I will update my teacher if anything with my health changes.

·  Please type your name to agree...:

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