PARQ – Sale Community Fitness

Physical Activity Readiness Questionnaire and Informed Consent Form

If You haven’t been active recently, or are looking to add a new exercise to your current routine, the physical activity readiness questionnaire (PAR Q) can help you decide if you are ready to exercise safely, or whether you should check with your doctor before you change your level or type of physical activity. Please contact us if you have any questions.

PARQ

When would you like to attend for your first session?

Personal Details

Name

Phone Number

DOB

Address

Address Line 1

Address Line 2

City

Postcode

Emergency Contact

Some description about this section

First Name

Last Name

Phone Number

Relationship

To promote a sports environment that is inclusive, fair and accessible we would like to collect information on your gender and ethnicity. This is on a voluntary basis and you are NOT required to answer these questions and should only do so if you are happy for us to process this data.

Gender

Male

Female

Gender Neutral

Prefer Not to Answer

Ethnicity

Asian or Asian British any Asian background eg. Bangladeshi, Chinese, Indian, Pakistani

Black, African, Black British or Caribbean Includes any Black background

Mixed or multiple ethnic groups Includes any Mixed background

White Includes any White background

Another ethnic group Includes any other ethnic group, for example, Arab

Prefer not to say

Physical Activity Readiness Questionnaire (PAR Q)

If you are over 69 years of age and are not used to being very active, please check with your doctor.
Please read each question carefully and answer honestly by Highlighting YES or NO.

If you answered “No” to ALL of the questions then you can be reasonably sure that you can undertake unrestricted physical activity. It is still important to start off slowly and increase gradually.

If you answered “YES” to one or more questions you should consult with your doctor before undertaking physical activity. Your doctor needs to advise you as to your suitability for physical activity. Please complete the details below once you have consulted with your doctor.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

Do you feel pain in your chest when you do physical activity?

Yes

In the past month, have you had chest pain when you were not doing physical activity?

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

Do you have a bone or joint injury (e.g. Back, Knee, Hip) which could be made worse by a change in your physical activity?

Yes

Is your Doctor currently prescribing medication for your blood pressure or heart condition?

Yes

Do you know of any other reason why you should NOT take part in physical activity?

Yes

If you answered Yes to the last question, please say why here:

Your GP Details

Name

Address

GP Surgery

Address

City

postcode

Date of Consultation

GP Consultation result

Unrestricted physical activity

Physical activity with the restriction of:

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Please note details of any injuries or illnesses, past or present that may have an effect on your ability to take part in physical activity.

I hereby confirm that I have read, understood and answered all the questions on the PARQ accurately. I understand that if my health changes, so that I then answer "YES" to any of the above questions I should inform Sale Community Fitness.

This form is an important legal document. It is important that you read and understand before signing.
1. I have read, understood and completed the PAR Q questionnaire and will seek guidance from my doctor prior to undertaking any physical activity/exercise where required to do so
2. I wish to participate in activities that may include aerobic, anaerobic, flexibility, stability, resistance, muscular strength and endurance exercise.
3. I accept that my participation in these activities involves the risk of injury and even the possibility of death.
4. I confirm that I am voluntarily engaging in a level of exercise that I consider acceptable and appropriate to my level of fitness.
5. Exercise programmes are designed to improve cardiovascular (heart & lungs) fitness, muscle strength, endurance as well as flexibility. I agree to notify the trainer if I feel I should not do a particular exercise.
6. Exercise programmes contain certain risks such as muscle strains, joint sprains, aches, pains and general discomfort from parts of the body not used to exercise. I understand that I am responsible for monitoring my own health status when exercising and will stop and /or call for assistance if appropriate.
7. Sale Community Fitness will always operate within current government guidelines for reducing the transmission of Covid 19. It will be a condition of acceptance in any training session that members agree to follow government guidelines at all times. I agree to follow Government Guidelines aimed at reducing the transmission of Covid 19 at all times. I understand that Sale Community Fitness reserve the right to ask me to discontinue training if these guidelines are not followed.
8. I understand that Sale Community Fitness reserves the right to cancel or suspend my membership where there are reasonable grounds to do so.
9. As I understand all of the above points I assume the risk and responsibility for any injury, illness or death resulting from my participation in group training and will not seek to penalise, prosecute or claim compensation from my trainer or Sale Community Fitness for any reason.
I have read this Informed Consent form, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily, without inducement.

Your privacy is important to us. For more details about how we use your personal data, please read our Privacy Notice for members.
We would like to send you additional information that is relevant to you about our services, promotional activities and events, we will not pass your details to third parties. You may opt out of receiving these communications at any time by emailing salecommunityfitness@gmail.com

I am happy for my photos to be used in this way.

We occasionally take photos and videos to promote Sale Community Fitness in the community and on social media which helps us to keep our community strong.

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