PAR-Q Form - Spirit Bootcamp

Our PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are unsure of your ability to exercise and not used to being very active, check with your doctor.

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 a chest pain when you were not doing physical activity?*

Yes
No

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

Yes
No

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

Yes
No

Are you diabetic?*

Yes
No

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

Yes
No

Are you pregnant or have you been pregnant in the last 6 months?*

Yes
No

Are you currently taking any medication? If yes, what and for what reason?*

Yes
No

Do you know of any other reason why you should not do physical activity?*

Yes
No

If you answered yes to any questions above please explain below:*

Is there anything else we need to know?*

Yes to one or more questions 1-4: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

Yes to one or more questions 5-10: You can be reasonably sure that it is safe for you to participate in physical activity proved special consideration is given to the above, gradually building up from your current ability level.

No to all questions: You can be reasonably sure that it is safe for you to participate in physical activity, gradually building up from your current ability level.

‘I have read, understood and accurately completed this questionnaire. I confirm that I am voluntary engaging in an acceptable level of exercise, and my participation involves a risk of injury.’*

I agree

Name*

First Last

Phone*

Emergency Contact*

Email*

Date Of Birth*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Which camp are you attending*

Leatherhead Leisure Centre 6.30AM
Leatherhead Leisure Centre 9.15AM
Dawnay School Bookham 6.30PM

How did you hear about us?

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