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Health Questionnaire (PAR-Q) & Informed Consent
Hayley Anderson Fitness

Please complete the following before participating in any of my online/zoom/on demand/face-to-face activities.

PAR-Q Physical Activity Readiness Questionnaire

This PAR-Q is designed to help you to help yourself.

There are many benefits are associated with regular exercise, and completion of the PAR-Q form is a first step to take if you are planning to increase the amount of physical activity in your life.

For most people, physical activity should not pose a problem or hazard. The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them.


Please read through and answer the following questions- if you answer YES to any of these questions, please elaborate on any question(s) you have answered "yes" in the box below.

1. Has your doctor ever said that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were NOT doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in physical activity?
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?
7. Are you currently pregnant or have you given birth within the last 6 months?
8. Are you recovering from a recent serious illness, operation or injury?
9. Have you ever suffered with Epilepsy? Please note that flashing lights are used in some of my classes
10. Have you ever had asthma, chronic bronchitis or other chest ailments?
11.Do you suffer from severe back pain or other orthopaedic problems?
12. Do you know of any other reason why you should not do physical activity?

If you have answered NO to all the above questions, you have reasonable assurance of your suitability for exercise

If you have answered YES to any of the above questions please get in touch with Hayley and you are advised to gain medical consent/approval before participating in the sessions.

I understand that if I have answered YES to any of the questions above I should seek medical advice/approval before commencing this class.

If I wish to continue without such advice I do so entirely at my own risk.
 

I confirm that I have read, fully understood and answered each question honestly.
 

I understand that neither the instructor nor Clubbercise Ltd nor Decades Reloaded can be held responsible for any injuries or ill health of any kind arising from participation within any classes. 

Please keep well hydrated and if you feel ill, in pain or unwell at any time, please stop immediately.
If you are currently positive for Covid-19, please do not attend face-to-face sessions.
 

Informed Consent for Exercise Participation

I wish to engage voluntarily in fitness classes with Hayley Anderson Fitness. I understand that I am responsible for monitoring my own condition throughout sessions. Should any unusual symptoms occur, I will cease my participation in that session.


In signing this consent form, I confirm that I understand the nature of exercise.
I know that there are always risks associated with fitness classes and accept those possibilities.


I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the fitness classes.

Thanks for submitting!

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