top of page

How will my information be used...? The information in the below form is kept strictly confidential for use by Steph at Steph J Dance & Fitness only to deliver safe classes and advise appropriately on participation. Your information will NEVER be sold or passed on to any third parties. The information in this form will not be used for marketing purposes without your explicit consent. Any data entered below will be subject to GDPR & Data Protection Regulation.

PAR-Q - Physical Activity Readiness Questionnaire

If you answer YES to any of the following questions, please obtain clearance from your GP before participating in classes


If you are over the age of 69, and not used to being very active, please check with your GP before participating in classes as a matter of course


This PAR-Q is designed to help you to help yourself. Many benefits are associated with regular exercise, and completion of the PAR-Q form is a sensible first step to take if you are planning to increase the amount of physical activity in your life.


For most people, physical activity should not pose a problem or hazard. 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.

Has your doctor ever said that you have a heart condition and should only take part in physical activity recommended by a doctor?
NO
YES
Do you have a bone or joint problem that could be made worse by physical activity?
NO
YES
Do you feel pain in your chest when doing physical activity?
NO
YES
Is your doctor prescribing you medication (eg water pills) for your blood pressure or heart?
NO
YES
In the past month, have you had chest pain when doing physical activity?
NO
YES
Do you lose balance because of dizziness or ever lose consciousness?
NO
YES
Do you know of any other reason why you should not participate in physical activity?
NO
YES

I hereby acknowledge:

​

  • My consent to participate in an exercise programme designed by a trained fitness consultant;

  • My understanding is that exercises will consist of one or more of the following components: free body cardiovascular, resistance (strength/endurance) and flexibility;

  • I fully appreciate that there are potential risks involved in participation, e.g episodes of transient light-headedness, or possibly loss of consciousness, and I assume willfully these risks;

  • I understand that I may stop or delay any exercise if I so desire, and that the class may be terminated by the fitness consultant upon observation of any symptoms of undue stress or abnormal response;

  • My understnading is that I may ask questions or request further explanation or information about the procedures at any time before, during and after the training;

  • That I have read, understood, and completed the medical screening (PAR-Q) and obtained medical consent if necessary

  • I confirm that where any medical condition, discomfort or injury which may be affected by physical activity applies or becomes applicable at any time when I am participating in a class, I am responsible for checking with my doctor to ensure I am able to participate in this activity.

bottom of page