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Call Natalie on 07738 249612
For more information about classes, events and nutrition!
natalie@fitjoy.co.uk

PAR-Q FORM


Name:
Address:
Mobile Number:
Date of Birth:
How Did you hear about this class:

EMERGENCY CONTACT NUMBERS:

Name & relationship:
Phone Number:

HEALTH QUESTIONS:

Does your child have or ever experienced the following?:

High or low Blood Pressure
Elevated Blood Cholesterol
Diabetes
Chest Pain brought on by physical exertion
Epilepsy
Dizziness or Fainting
A bone, joint or muscular problem or arthrisitis
Asthma or other respiratory problems
Any sustained injuries or illnesses
Any allergies
Are you taking any medication
Has your doctor ever advised you not to exercise
Is there any reason not mentioned above why any type of physical activity may not be suitable for you?
If you have answered yes to any of the questions please give full details here:
Any special dietary needs?:
I give permission to be in a photo/video for Fitjoy promotion that may be used in a poster or Fitjoy website?
Date:
I agree the information above is true and correct.

In submitting this form, I affirm that I have read this form in its entirety and I have answered the questions accurately and to the best of my knowledge.