Active Communities Team Registration & PAR-Q  (Phase 4)
Physical Activity Readiness Questionnaire

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Email *
Full Name (including titles) *
Contact Number *
Date of Birth
How old are you? *
Gender *
Postcode *
Do you consider yourself to be physically active? Reason *
How many minutes a week do you take part in physical activity? *
Ethnic Origin: Please specify your ethnicity *
Do you have any of the following health conditions? *
Emergency Contact Number and Name *
If you have a condition above please consult with your doctor and confirm that it is safe for you to exercise. If you have not seen a doctor for the condition then you are advised to not partake in the physical activities, until you do. If you have not selected a condition it is reasonably safe for you to participate in physical activity, gradually building up from your current ability. Please confirm you have read and understood the above. *
We provide various outdoor, indoor and online (zoom activities) throughout the campaign. And our teams cater to different needs. Which team would you prefer? *
Are you happy for a team member to contact you for further details and provide information about us? *
What language do you prefer to speak in? Do you speak any other languages? Which ones? *
How did you hear about us? *
Your Data - The purpose of us asking for this data is primarily for your safety and the monitoring of equal opportunities.  This information will be stored only by the organisers working within the campaign and will only be stored for the duration of the campaign. Please select your preferred option regarding your data below; *
Photo consent - I hereby grant permission to Active Communities Team (ACT) full and free use of photographs and videos containing my image. I understand these images may be used for promotional, news, research and/or educational purposes on the internet or printed publications.   *
Thank you for filling in this Introductory Par-Q form.  You will receive an email with our current timetables and a zoom link for online activities. Kindly ensure that you have your full name displayed on your screen for access to our online activities. If you do not receive a link please check your email junk box. We will be in touch with you as well, to assist on your journey of well-being and discuss further steps in-depth. We look forward to getting ACTIVE together! In the meanwhile, if you have any queries or for further information please email us on: *
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