Simon Beatson Personal Training and Sports Therapy

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Please use this quick form to provide your contact info and answer the PARQ (Physical Activity Readiness Questionnaire) questions to ensure you can take part in your trial class safely. Doing this now will save lots of time before the class, so thank you for making the advance effort.

Please don’t hesitate to get in touch if you have any queries or concerns at all.

ASK A QUESTION

Name

First Name

Last Name

When do you wish to attend for your free trial?

YYYY

Email Address

Phone number

Date of birth

YYYY

Name of emergency contact

Phone number for emergency contact

Where did you hear about us? If a friend recommended the class then please add their name

Physical Activity Readiness Questionnaire

Many health benefits are associated with regular exercise, and the completion of PAR‐Q 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 any problem or hazard. PAR‐Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?

Do you have high blood pressure?

Do you have low blood pressure?

Do you have Diabetes Mellitus or any other metabolic disease?

Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)?

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Have you ever felt pain in your chest when you do physical exercise?

Is your doctor currently prescribing you drugs or medication?

Have you ever suffered from unusual shortness of breath at rest, or with mild exertion?

Is there any history of Coronary Heart Disease in your family?

Do you often feel faint, have spells of severe dizziness or have lost consciousness?

Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 for women)?

Do you currently smoke?

Do you NOT currently exercise at least 3 times per week and/or work in a job that is physically demanding?

Do you know of any other reason why you should not participate in a program of physical activity?

If you answered 'yes' to one or more questions:

If you have not recently done so, consult with your doctor as to your suitability for these sessions, and before increasing your physical activity.

If you answered 'no' to all questions:

If you answered PAR‐Q accurately, you have reasonable assurance of your present suitability for a fitness appraisal and graduated exercise programme. Please note that even if you answered ‘no’ to all questions, you should delay becoming more active if you are temporarily ill with a cold or a fever, or if you are or may be pregnant. If your health changes so that you then answer ‘yes’ to any of the above questions, tell your doctor and your fitness or health professional and ask whether you should change your physical activity plan.

Confirmation

I hereby state that I have read, understood and answered honestly the questions on the PAR‐Q. I also state that I wish to participate in physical activity with a personal trainer, and agree to do so entirely at my own risk. I realise that my participation in these activities involves risk of injury, illness and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me. Participants who answered 'yes' to one or more question also confirm that they have taken medical advice and the doctor has agreed that they should exercise.

Date

YYYY

DATA USE: I confirm that I am happy to share the above health and contact data information, and for it to be held on file and used for the purposes of providing safe and effective sessions and for keeping me up-to-date with any news about the training relationship and/or Simon Beatson Personal Training, now and in the future. *

BOA BOOTCAMP BOOKING FORM

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