TEEN PAR-Q

About you

The information in this section is about the TEEN

First name *

Last name *

Email address *

Phone *

Date of birth *

Day

Month

Year

School year *

Street Address

City

Postcode

Country

Parent/Guardian

Emergency contact

Name and surname *

Relationship *

Mobile phone number *

Physical Activity Readiness Questionnaire (PAR-Q)

Does your child have or have they ever experienced any of the following:

High or low blood pressure *YesNo

Elevated blood cholesterol *YesNo

Diabetes *YesNo

Chest pains brought on by physical activity *YesNo

Childhood epilepsy *YesNo

Dizziness or fainting *YesNo

A bone, joint or muscular problem with arthritis *YesNo

Asthma or other respiratory problems *YesNo

Any sustained injuries or illness *YesNo

Any allergies *YesNo

Is your child taking any medication *YesNo

Has your doctor ever advised your child to exercise *YesNo

Is there any reason not mentioned above why any type of physical activity may not be suitable for your child? *YesNo

If you answered yes to any of the previous question, please provide full details here:

Terms and conditions

In signing this form, I the parent/guardian of the aforementioned child, affirm that I have read this form in its entirety and I have answered the questions accurately and to the best of my knowledge. I declare to the best of my knowledge of no reason why my child should not participate in a personalised programme entirely at their own risk and waive any legal recourse for damages or property arising from their participation. I understand that my child is responsible for monitoring him or herself throughout any activity, and should any unusual symptoms occur, would cease participation and inform the instructor. In the event that medical clearance must be obtained prior to my child’s participation in an exercise session, I agree to contact the GP and obtain written permission prior to the commencement of the exercise activity, and that this permission be given to the instructor. I understand that if my child fails to behave in a manner that is polite and social, and does not abide by ace lifestyle regulations, he or she could be removed from that particular activity.

Signed *

In consideration of being able to take part in exercise and physical activity organised by ace lifestyle, I acknowledge that I am physically fit for participating in ace lifestyle activities. I agree to abide by all verbal and written notices regarding safety whilst exercising with ace lifestyle. ace lifestyle shall not be liable for any injury or death I may suffer in these activities.

Signed *

Full Name *

TEEN PAR-Q

About you

The information in this section is about the TEEN

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