Vanquish PAR-Q Form
Please complete the following form, which will inform us of any existing health conditions that we should be aware of, therefore we are able to support you further with your Vanquish journey.  

This is required before you attend your first Vanquish class.

All details provided will be kept strictly confidential under the Data Protection Act 1998. Should you wish to see our Data Protection policy, please do not hesitate to email Danika [danika@steppinup.co.uk] to gain access to this document.
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Vanquish PAR-Q Form
Please state TITLE, FIRST & LAST NAME
Age, or DOB:
Gender:
Address & Postcode
Contact Details: Email & Number
Emergency Contact Details: Number & Relationship To You
Please answer the following questions as honestly as you can and provide as much relevant additional information. Please answer the following questions by circling YES or NO (Should you answer Yes to any of the questions, please provide further information in the space provided)
Do you currently, or have you ever suffered from any of the following?
YES
NO
Heart problems?
Circulatory problems?
Blood pressure problems?
Joint & movement problems?
Feel dizzy, or imbalanced during exercise?
Currently pregnant, or recently given birth?
Clear selection
If you answered YES to any of the above, please provide details below:
Are you impacted by any of the following, and/or are you receiving medical care?
YES
NO
Back/Spinal Pain?
Headaches and/or Migraines
Have you recently had surgery?
Currently being prescribed medication?
Recently finished a course of medication?
Diabetes?
Asthma and Breathing Problems?
Clear selection
Declaration: I have answered all the above questions honestly, and I am aware that if I have answered YES to any of the questions, I will need to consult my General Practitioner, before commencing an exercise programme if I am affected by any of the conditions mentioned in the form. I agree to inform my personal trainer, or instructor on any changes in my health or fitness. (Please electronically sign, print your name and state the date of which you have completed this)
Submit
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