Decades Dance Fitness PAR-Q

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Physical activity readiness questionnaire.

Becoming more active is very safe for most people. However, some people should check with their doctor before becoming much more physically active. Please answer the questions honestly.

Question 1: Has your doctor ever said that you have a heart condition and that you should only do physical activity recommend by a doctor? *

Yes

Question 2: Do you feel pain in your chest when you do physical activity? *

Yes

Question 3: In the past month, have you had chest pain when you were NOT doing physical activity? *

Yes

Question 4: Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

Question 5: Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *

Yes

Question 6: Is your doctor currently prescribing medication for your blood pressure or heart conditions? *

Yes

Question 7: If you have had COVID-19, are you experiencing any signs or symptoms of what is known as Long-COVID? Have you noticed any worsening of your energy levels or physical activity? *

Yes

N/A

Question 8: Do you know of any other reason why you should NOT do physical activity? *

Yes

Question 9: Are you over 69 years of age? *

Yes

Question 10: Are you or could you be pregnant? *

Yes

If you answered YES to any of these questions:

Talk to your doctor on the phone or in person BEFORE you start becoming more physically active. Tell your doctor about the PAR-Q and which questions you answered YES.

You may be able to do any activity as long as you start slowly and build up gradually. Or you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow their advice.

If you answered NO to all questions:

You can be reasonably sure that you can start becoming much more physically active. Begin slowly and build up gradually. This is the safest and easiest way to go.

Important note for everyone:

If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

If you feel unwell because of a temporary illness such as a cold or fever, wait until you feel better.

Is there anything else you'd like to tell your instructor? Do you have any questions? If so, please use the space below:

I have read, understood and completed this questionnaire. I agree that if my health status changes, I will inform my instructor. *

Yes

Name: *

E-mail address: *

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 9 questions.

GDPR and Data Protection: DECADES takes your privacy seriously and will never share your details with any third parties. We will only contact you if we have important information about your health form/class booking. If you no longer wish to hear from us, or wish to request a copy of the information held about you, please get in touch by e-mailing lulabel_177@hotmail.com

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