Under 16 PARQ - Parental Consent

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Please fill out this form prior to you child taking part in any physical exercise with Aphrodite Fitness. Please get in contact directly to discuss any concerns you may have.

Childs Name *

Date of Birth *

YYYY

Current School year *

Address *

Childs Doctor / Surgery *

Parents Name *

Contact Number *

Email Address *

Has your child ever suffered from the following (please select applicable)

High or Low Blood pressure

Elevated Cholesterol

Diabetes

Chest Pains brought on by exercise

Childhood Epilepsy

Dizziness or fainting

Bone, joint or muscular problems with arthritis

Asthma or respiratory problems

Any sustained injuries or illness

Allergies

Taking medication

Has your doctor advised your child to exercise

Is there any reason not mentioned above why any type or physical activity may not be suitable for your child

If you have selected any of the options above, please give details

In the absence of a parent/ guardian, I understand that my child is responsible for monitoring him or herself throughout any activity, and should any unusual symptoms occur, would ease participation and inform the instructor.

In the event that medical clearance must be obtained before my child’s participation in an exercise session, I agree to contact the GP and obtain written permission prior to the commencement of the exercise activity, and that the permission is given to the instructor/ Personal trainer.
I understand that if my child fails to behave in a manner that is polite and social, he or she could be suspended from that particular activity

In signing this form, I the parent/guardian of the aforementioned child, affirm that I have read this form in its entirety; I have answered the questions accurately and to the best of my knowledge

I the parent/ guardian of the aforementioned child give permission for him/her to participate in the session and understand that the Fitness instructor/ Personal trainer taking the exercise sessions cannot be liable for any loss or personal injury

Print name (Parent) *

Please print again as signature *

Date *

YYYY

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