Fylde Coast Weightlifting PARQ & Permissions

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Please complete the below Physical Activity Readiness Questionnaire (PARQ) and the video/photography consent forms for Fylde Coast Weightlifting Club.

Your full name *

Your email address *

Your contact number *

In case of emergency information

Please detail a person and their details who can be contacted in case of an emergency

Emergency contact full name *

Emergency contact phone number *

Key information

Please answer all the questions below, and expand on anything you require in the free text below the questions to provide more details or context.

Key info ... *

Yes

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

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

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

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

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?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

Yes

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

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

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

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

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?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

YES to one or more questions?

Talk with your doctor by phone or in person before you start becoming much more physically active.
Tell your doctor about the PAR-Q and which questions you answered yes.
Find out which community programs are safe and helpful for you, if weightlifting is permitted.
It is also advised you ask about any limitations and request your GP’s written approval and guidance.
A written guidance or approval from your physiotherapist and/specialist will also be accepted as an alternative to your GP. This may also be accepted when sent by email.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you:

Agree to physical activity including resistance exercises (weightlifting).
Agree to gradually progress your lifting, under the guidance of coaches leading the session.
Agree to inform coaches, should your health status change or if you have any new injuries.

Any other information we should know about?

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