Aerial Fitness & Fun - Adult PAR-Q

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Physical Activity Readiness Questionnaire

Email *

Full Name *

Address *

Contact Number *

Date of Birth *

YYYY

How many times per week do you currently exercise?

What form does this exercise take? *

What form does this exercise take?
*

How would you describe your general health?
*

Excellent

Very good

Good

Fair

Poor

Do you suffer from any respiratory disorders?
*

Yes’s

Do you suffer from any heart conditions?
*

Yes

Do you suffer from dizzy spells, fainting or balance problems?
*

Yes

Do you currently have any physical conditions?
*

Yes

Please indicate any other health problems that we should be aware of (recent operations, injuries, pregnancy, pre or post natal issues, etc)

Do you suffer from any mental health issues?
*

Yes

(Optional) If you have answered yes to the above, please disclose the nature of the issue

If you have answered yes to any of the above questions, please ensure that you have discussed your ability to participate in these aerial activities with your doctor or GP before submitting this PAR-Q.

confirm that any issues will be discussed with a doctor before completing this form

All measures have been taken to minimise the risks involved in aerial fitness, however the risk cannot be eliminated completely. By completing this form, you state that you understand that in participating in aerial fitness classes you may experience some bruising, sore muscles and sore hands.

I understand the risks outlined above

Required

If there are any changes to the above information you must advise Aerial Fitness and Fun immediately.
*

If my information changes, I will inform Aerial Fitness and Fun immediately

Required

I confirm that I have answered all questions to the best of my knowledge and the information is correct.
*

The information I have provided is correct to the best of my knowledge

Required

Aerial fitness and fun will hold your information in accordance with current GDPR legislation. By providing this information you consent to the using of your data in order for us to administer your lessons. Your details will not be forwarded to any third parties.

I consent to Aerial Fitness and Fun using my data in order to administer my lessons

Required

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