PARQ Health Questionnaire
Please read the questions carefully and answer each one honestly, ticking the appropriate box or adding
information if necessary. Your responses will of course be kept in the strictest confidence. This form must be
completed, returned to be assessed by your instructor prior to availing the induction services.
Name *
Your answer
Phone Number *
Your answer
Post Code *
Your answer
Email Address *
Your answer
Would you like to join a closed FaceBook Group for Regular Tips & Advice? *
Facebook Name (if different)
Your answer
How did you hear about us? *
Would you like to be added to our subscription list (Receive important class updates & exclusive offers at THE HOPE CENTRE!) *
Gender *
Emergency Contact Person *
Your answer
Contact Number *
Your answer
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