Date of Birth:
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Is your doctor currently prescribing drugs to you (for example water pills) for blood pressure or a heart problem?
Do you ever feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you are not doing physical activity?
Do you ever feel faint or have spells of dizziness?
Do you suffer from shortness of breath at any time or a respiratory condition that would prevent you from doing physical activity?
Do you have any joint problems (including neck, back and hip) that could be made worse by exercise, including jumping and landing?
Are you pregnant or have you given birth in the last 6 months?
Do you have a condition requiring medication or are you taking medication which would prevent you from doing physical activity?
Have you been hospitalised in the last 12 months and is there any other medical condition or disease that you have been affected by?
I have read and understood the PARQ form above and declare that:
I do not suffer from any of the conditions mentioned or any other condition or injury that would prevent me from taking part in a programme of personal training/bootcamps.
Please note: Your completed form will be printed out for you to sign on arrival at your first bootcamp/fitness session.
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