SHAPE Performance Coaching PAR-Q
Physical Activity Readiness Questionnaire (PAR-Q)

Please complete this form for any children attending a SHAPE Performance Coaching course or holiday club.

The parents or legal carers of a person under 18 years of age must complete and sign the form. Please be honest when completing the form. Having certain medical conditions do not necessarily mean that you/they cannot join in. If you answer ‘yes’ to any of the questions please outline in the space provided the nature of the issue and whether this is likely to influence your/their ability to complete the training.

Section 1 is for you to provide your details and those of any other parents/carers. We recommend that you provide emergency contact details for at least 1 other person, e.g. a grandparent.

Please note that we will not sell or distribute your details to any other companies. We rarely send out marketing emails or texts newsletters and you can 'opt out' of any marketing information being sent to you.

Email address *
Parent/Carer 1 - full name *
Please add one parent/carer's name, there is space for another parent/carer if required.
Your answer
Parent/Carer 1 - What is your relationship to child? *
Parent/Carer 1 - mobile phone number *
Don't worry we won't pass on your details to any other companies and you can 'opt out' from contact from us.
Your answer
Parent/Carer 1 - alternative phone number(s)
If we need to contact you in an emergency and have another contact number, e.g. work or office, please provide them below.
Your answer
Address - number of house and street *
Your answer
Address - Town *
Your answer
Address - County *
Your answer
Address - post code *
Your answer
Parent/Carer 2 - name
Please add another parent/carer's name who we are able to contact in an emergency. E.g. partner, grandparent etc.
Your answer
Parent/Carer 2 - What is their relationship to the child?
Parent/Carer 2 - mobile phone number
Don't worry we won't pass on your details to any other companies and you can 'opt out' from contact from us.
Your answer
Parent/Carer 2 - alternative phone number(s)
If we need to contact them in an emergency is there another number we can contact them on. E.g. work/office number.
Your answer
Other Emergency contact 1 - name
Is there anyone (WHO HAS NOT ALREADY BEEN MENTIONED), who we can contact in an emergency? Please name them here
Your answer
Other Emergency contact 1 - What is their relationship to the child?
Other Emergency contact 1 - phone number
Your answer
Other Emergency contact 2 - name
Is there anyone (WHO HAS NOT ALREADY BEEN MENTIONED), who we can contact in an emergency? Please name them here
Your answer
Other Emergency contact 2 - What is their relationship to the child?
Other Emergency contact 2 - phone number
Your answer
Comments - please add any comments about the emergency contacts. E.g. if you usually have your mobile phone switched off at work or if you work away for a few days in the week which contact should we use etc.
Your answer
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