PAR-Q

Below is a physical activity readiness questionnaire, which must be completed and submitted before attending any UK jump rope club in association with The Jump Rope Company Ltd.

Contact Details

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

How would you prefer to be contacted?

Tick all that apply

Phone

Emergency Contact

First Name

Last Name

Emergency Phone

Which club/event are you interested in joining?

Physical Activity Readiness Questionnaire

Please read each question carefully and answer honestly by ticking all that apply. If you're over 50, you may need permission from your doctor before praticipating in vigorous exercise.

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

Do you ever feel pain in your chest when you do physical activity?

In the past month, have you had any chest pain when you were not doing physical activity?

Do you sometimes lose balance because or dizziness of do you ever lose consciousness?

Do you have a bone or joint problem (e.g. back, knee or hip) that could be made worse through physical activity?

Is your doctor currently prescribing medication for blood pressure or a heart condition?

Do you know of any other reason why you should not take part in physical activity?

If "yes", please provide more information below.

If you answered "yes" to one or more questions above, you must consult your doctor before participating in physical activity to confirm it is safe to do so.

Declaration / Waiver

By ticking you agree that the following statements are accurate.

I have read, understood and have accurately completed the questionnaire to the best of my knowledge.

I agree

I am voluntarily engaging in an appropriate level of physical activity and acknowledge that this involves a risk of injury.

I agree

I will inform you, in the event that my circumstances change, to update my records so that the information on file remains accurate.

I agree

Social Media Agreement

I am happy to appear in photos/videos which may be shared publicly on the jump rope club's social media channels.

I agree

I am under 18 and have my legal guardian's permission

I do not agree

If you have any questions regarding the completion of your PAR-Q, please get in touch.

PAR-Q

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