Physical Activity Readiness Questionnaire (PAR-Q)
NAME: DATE:
PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible 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 any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.
Common sense is your best guide in answering these few questions. Please read them carefully and check the “yes” or “no” box opposite the question if it applies to you.
Please TICK the questions below.
1. Has your doctor ever said you have heart trouble?
2. Do you frequently have pains in your heart and chest?
3. Do you often feel faint or have spells of severe dizziness? 4. Has a doctor ever said your blood pressure is too high?
5. Has your doctor ever told you that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?
7. Are you over the age of 65 and not accustomed to vigorous exercise?
YES NO

IF YOU ANSWERED YES TO ONE OR MORE QUESTIONS
If you have not recently done so, consult with your personal physician by telephone or in person BEFORE increasing your physical activity and/or taking a fitness appraisal. Tell your physician what questions you answered yes to on PAR-Q, or present your PAR-Q copy.
After medical evaluation, seek advice from your GP or doctor as to your suitability for: • unrestricted physical activity starting off easily and progressing gradually
• restricted or supervised activity to meet your specific needs, at least on an initial basis (Check in your community for special programs or services.)
IF YOU ANSWERED NO TO ALL QUESTIONS
If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for:
• a graduated exercise program (A gradual increase in proper exercise promotes good fitness development while minimising or eliminating discomfort.)
• a fitness appraisal
Postpone exercise if you have a temporary minor illness, such as a common cold.
Please list below any other information that may be useful or required in order for your trainer to instruct you safely and carefully through an exercise class or programme.
Signed : Date:…………………….
Karen Porter
Life Coach & NLP practitioner Fitness Coach

GDPR Policy – What you Need to Know

Why are Body and health by Design collecting Data and How will it be used?
• To be able to plan to meet the needs of participants during the sessions
• To obtain contact information of individuals for emergencies or to promote 
 future events
• Promotion of future events using your data will only ever be via email from 
 karen@bodyandhealthbydesign.com
• To be made aware of any medical requirements and conditions that the participants or guardians may have so access and communication allowances can be put in place
Who has access to the data once I have completed the form and where will it be stored?
• Karen Porter will be the only person that has access to the data
• The data will be stored on a secured device with password protection, this device is stored in a secure location
• Once data has been received and stored onto the device the paper copies will be kept in a secure file as evidence of participant consent being given for yourself to participate in the classes or programmes and that the person is aware of the policies and procedures.

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What other Organisations will the data be shared with? NONE
Any further promotional emails that you receive will come directly from Body and Health by Design and whilst we may promote other organisations to you, these organisations will NOT be given your details or personal information by Body and Health by Design.
Management of Data
Your data will remain in our database until you inform us that you no longer wish to receive
Consent

By completing the Health Screen and/or Waiver form or the personal contact for (depending upon which service you are engaged in) you are agreeing to Body and Health by Design using the data you provide for the purposes outlined above.