All information on this form will be treated as confidential.

Please complete this PAR Q form, if you are seeing me for the first time, or, if you are an annual returner to any of my classes.  This should be done prior to you joining any class.

Your Details

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Please read each question carefully and answer honestly by ticking YES or NO

 
 
 
 
 
 
 
 

Questionnaire continued

 
 
 
 

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IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS:Talk to your Doctor by phone or in person before you start becoming more physically active.  Tell your doctor about the questionnaire and which question you answered yes to. 

IF YOU HAVE ANSWERED NO TO ALL QUESTIONS:You can be reasonably sure you can start to become more physically active and take part in a suitable exercise programme.

Emergency Contact Details

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Your GP Details

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Declaration

I have read, understood and completed this form. 
I confirm I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.

Any questions I had were answered to my full satisfaction. I will inform the instructor of any new or unusual symptoms; changes in my medication; results of any investigations or treatment.  
I also agree to my GP being contacted if deemed necessary & to share health information with my chosen clinician if need be.

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Date