MissFits Workout Contact Information and Physical Readiness Questionnaire (PAR-Q)
If you would like to take part in any MissFits Workout online classes you must complete this form in full. Make sure you have also read the MissFits Mandate (I have read the MissFits Mandate and agree to abide by these instructions for the safety and comfort of myself and others. (https://www.missfitsworkout.co.uk/missfits-mandate)

The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense is your best guide for answering these questions.

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Full Name *
Which pronouns do you use? (e.g. she/her)
Email address *
Date of birth *
MM
/
DD
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YYYY
Next of kin and their contact details (or someone I can contact in an emergency to help you during a live online/face to face class) *
Are you looking to take part in the pre-recorded  YouTube videos and/or live Zoom classes? *
Do any of the following statements apply to you? *
If you answer YES to any of the below questions, then you are required to gain consent from your doctor before participating in a MissFits online exercise session.
Yes
No
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 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?
Have you had COVID-19? *
If you said yes to having had COVID-19, have you experienced what you consider to be any signs or symptoms of Long-COVID? If yes please give details:
If you said yes to having had COVID-19,  have you noticed any changes to your normal level of energy, physical activity or exercise that has been altered or seems to be worsened since your exposure to the virus? If yes please give details:
Declaration *
Please read and tick to confirm agreement.
Tick to confirm
I have answered NO to the above questions and I have reasonable assurance of my suitability for a MissFits exercise session
I understand that I must postpone participation in the session if I feel unwell or have a temporary illness.
I will inform my instructor of any changes to my health status (including pregnancy), whilst engaged in any MissFits sessions
I have read this form and the MissFits Mandate statement. This MissFits exercise to music session has been explained to me and my questions regarding the session have been answered to my satisfaction.
I understand that I am free to withdraw at any time.
I give permission for MissFits to contact me by email with details of online classes and links to Zoom streamed/live classes. I can 'opt out' by email at any time
I understand that the information obtained will be treated as private and confidential
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