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Physical Activity Readiness Questionnaire 

This PAR-Q helps you take responsibility for your own safety.

Regular exercise has many benefits, and completing this form is a sensible first step before increasing your activity levels.

For most people, physical activity is safe and poses no risk.

The PAR-Q identifies those who may need medical advice before exercising.

Please use common sense when answering the questions.

Date of birth
Day
Month
Year
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
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?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Do you think you could be pregnant, are pregnant or had a baby in the last 6 weeks?
Yes
No
Do you know of any other reason why you should not take part in physical activity?:
Yes
No

If you have answered:

  • NO, to all the above questions and you have reasonable assurance of your suitability for exercise, sign the participant declaration below

  • YES, to any of the above questions, then you are required to gain consent from your doctor before participating in Kangoo Jumps group exercise.

Delay becoming more active if:

  • You have a temporary illness such as a cold or fever; it is best to wait until you feel better.

  • Your health changes - talk to your doctor or qualified exercise professional before continuing with any physical activity program.

Participant declaration

Please note that no liability is accepted for any loss of or damage to any articles, which you may bring with you to classes. Equally, liability is not accepted for loss of or damage to motor vehicles or their contents and these are left at the owner’s risk.

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.

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