Walton Volleyball Club Registration Form

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Please complete this form to register with the club. It should take just a few minutes to fill in.

Email *

First Name *

Surname *

Mobile Phone Number *

Address *

Gender *

Female

Male

Other

Age *

Please select your age range

PAR Q (Physical Activity Readiness Questionnaire) *

If you answer YES or UNSURE to any of these questions then we recommend that you seek advice from a medical professional before significantly increasing your levels of physical activity.

YES

UNSURE

Has your doctor ever diagnosed you with a heart condition or stated that you should only undertake exercise recommended by them?

Do you feel pain in your chest when you undertake exercise?

Do you feel pains in your chest when you are NOT undertaking physical activity?

Do you ever suffer from dizziness or a loss of consciousness?

Do you have bone or joint problems that are made worse when you move?

Are you currently taking any form of medication that could affect physical activity?

Do you know of any reason why you cannot perform physical activity?

YES

UNSURE

Has your doctor ever diagnosed you with a heart condition or stated that you should only undertake exercise recommended by them?

Do you feel pain in your chest when you undertake exercise?

Do you feel pains in your chest when you are NOT undertaking physical activity?

Do you ever suffer from dizziness or a loss of consciousness?

Do you have bone or joint problems that are made worse when you move?

Are you currently taking any form of medication that could affect physical activity?

Do you know of any reason why you cannot perform physical activity?

Further Details

Please inform us if there is anything you think we should know about regarding your physical readiness to play volleyball.

Emergency Contact *

Please add contact details of someone we can get in touch with in case of emergencies.

Thank you for completing this form and welcome to Walton Volleyball Club!

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