Par-Q Update

Personal Details
Name:
Address:
  Post Code:
Home Tel: Work Tel:
Mobile Tel: Email:
Occupation: Date of Birth:

 

Please detail any other changes to your health & wellbeing  
 
 
 
 
 
 
 
 
 
 
 
 

 

 

Declaration
I can confirm that to the best of my knowledge, the information I have given is correct.  I understand that I need to inform my fitness professional if my medical or health conditions change and that it is my responsibility to check with my doctor before following any advice or information provided by a fitness professional.

I understand that there is an element of risk associated with any physically demanding activity, and as a condition of participation I accept complete responsibility for my own physical and emotional wellbeing

Print Name:

 

Date:
Signed: