Jumpingwithus PAR-Q form
Physical Activity Readiness Questionnaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day.
Being more active is very safe for most people. However, some people should check with their doctor before they start
becoming much more physically active.

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you
significantly change you physical activity patterns. Common sense is your best guide when you answer these questions.

If you are 69+. You need to make sure or check with your doctor if its okay for you to significantly change your physical activity patterns.

Please read the questions carefully and answer each one honestly: simply answer YES or NO, otherwise all answers or no
answers equal to NO. /Maybe, not sure, hope not/.

First name
Your answer
Surname
Your answer
Date of birth
MM
/
DD
/
YYYY
Today's Date
MM
/
DD
/
YYYY
Address
Your answer
Email Address
Your answer
Mobile number
Your answer
Emergency contact (email/mobile)
Your answer
Are you pregnant?
PLEASE AWARE because of the nature of this workout and Health and Safety regulation, we CAN NOT allow clients on the trampolines if you are pregnant
I weigh under 100kg (15.7 stones)
PLEASE AWARE because of the nature of this workout and Health and Safety regulation, we CAN NOT allow clients on the trampoline weighing more then 100kg - 15.7 stones.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
PLEASE AWARE because of the nature of this workout and Health and Safety regulation, we CAN NOT allow clients on the trampolines if you have a heart condition.
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