Beez Kneez
PAR Q Form
Name *
Telephone *
Address
Postcode
Email *
Date of Birth
Name & telephone of emergency contact *
Name & telephone of doctor *
How old is your youngest child?

PAR-Q Questions

Please read the following questions carefully and thoroughly. Answer each question honestly to the best of your knowledge by ticking either yes or no. If you answer yes to any of these, we will need to get a letter from your GP.

Please indicate if you have you experienced any of the following answering yes/no
Have you ever suffered a miscarriage?
Did you currently participate in an exercise programme?
Have you had any problems or bad experiences with any exercise programme in the past?
Have you ever had a multi-birth pregnancy?
Do you have any conditions or past injuries that may limit the range of movement on your joints, bones, muscles, spinal column or any other part of your body?
Have you been referred to an exercise programme?
Do you suffer from high or low blood pressure or have elevated blood pressure?
Do you have any thyroid problems?
Have you suffered from any heart condition e.g. angina or had any tightness or pains in the chest?
Do you have Diabetes Mellitus?
Have you suffered from high cholesterol levels?
Do you, or have you ever suffered from Asthma or any respiratory disorder?
Do you lose consciousness or fall over as a result of dizziness?
Have you ever, or do you currently smoke?
Have you ever had Symphasis Pubis Dysfunction?
Are you taking any medication?
Do you feel stressed or under pressure?
Has any person in your immediate family ever suffered from Coronary Heart Disease or circulatory disease?
Are you pregnant or have you been pregnant in the past three months?
PLEASE NOTE: You need to agree to the client disclaimer below before participating in our workouts. Please read through and put a tick in the box provided

You acknowledge that certain elements of the Sessions can be physically demanding and you are aware of the nature of the Sessions and the associated risks involved. As a condition of your enrolment, you agree that you are physically capable of participating in the Sessions and accept full and complete responsibility for your own participation in the Sessions. You agree that should any medical or physical arise prior to or during a Session which is likely to affect your ability to participate in a Session you will not attend / will withdraw from the Session. Without limiting the foregoing, before taking part in any Sessions you must complete a [PAR-Q] and if appropriate seek advice from your doctor. You agree and acknowledge that, if required, it is your obligation to take out personal accident and personal items insurance and that it is your responsibility to store any valuables in a safe place. You agree that The Beez Kneez liability for personal injury, death or loss or damage to property is limited to any damage or loss suffered as a direct result of the negligence of The Beez Kneez or its employees or agents. You further agree that The Beez Kneez shall not be liable to you for any indirect or consequential loss or damage including loss of earnings arising out of your participation in the Sessions nor for an aggregate amount greater than the fee paid for the Sessions. If there is anything else we need to know regarding your health & fitness, please let us know.
I agree to the terms and conditions stated above
Enter the black letters you see in the image *
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