Health Questionnaire

JH Fitness Waiver and PAR Q Form

Please fill in the health questionnaire before your first class

Many health benefits are associated with regular exercise. For most people, physical activity should not pose any problem or hazard. There are a certain amount of benefits and risks associated with any type of physical activity. The PAR-Q is a simple self-screening tool that is designed to help uncover any potential health risks associated with exercise.

1. Have you ever suffered from epilepsy/photosensitive epilepsy?

2. Are you pregnant?

If yes, how many months

3. Have you given birth in the last 16 weeks?

4. Have you ever suffered from heart trouble/a heart condition and that you should only do physical activity recommended by a doctor?

5. Are you presently taking any form of medication?

If yes please comment here

6. Do you suffer from chest pains? (either when you are undertaking physical activity or not)

7. Do you ever have spells of dizziness or feel faint and lose balance or consciousness because of this?

8. Have you ever had either high or low blood pressure, and/or high cholesterol?

9. Have you ever had asthma, chronic bronchitis or any other chest ailments? If you have asthma are you currently using an inhaler and do you have it on your person?

10. Do you have bone, joint or muscle problems (for example, back, knee, or hip) that could be made worse by a change in your physical activity?

11. Do you suffer from severe headaches or migraines?

12. Are you recovering from a recent illness/operation or injury?

13. Have you any other medical conditions that we should be aware of?

14. Is there any history of heart disease in your immediate family (before age 55)?

15. Are you allergic to anything? If yes do you need an EpiPen and have you got it on your person?

16. Do you currently have any of the main current COVID-19 symptoms which are?
- The loss or change to your sense of smell and taste

- A Continuous cough or 3 or more coughing episodes in 24 hour period

- A high temperature (which means you feel hot to touch on your chest or back

17. Have you had a common cold symptom or been feeling unwell in the last 14 days?

18. Have you been told to self-isolate or has anyone in your household (including anyone in your support bubble if applicable) had or currently have COVID-19 symptoms or been told to self-isolate in the last 14 days?

19. Have you been told you should be shielding, are classed as vulnerable/clinically high risk or live with someone who is where you cannot keep a 2m distance from them?

20. Have you been abroad to any country not currently in the travel corridor list in the last 14 days for leisure or work (unless exempt)?

Please comment in the box below of any health issues/conditions you have or any injuries old or new, or if you have answered yes to any of the above questions.

PLEASE NOTE: If any of the above answers change at any time, please inform a member of JH Fitness before taking in part in any exercise. Should you fail to do so, JH Fitness cannot be held liable or responsible for an injury or any associated issues.

I consent to receive:
Class updates (including but not limited to changes, cancellations, etc)
Generic updates (including but not limited to updates regarding the timetable, pricing changes, etc)
Marketing emails (including but not limited to newsletters, promotions, offers, etc).

I confirm I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. I agree that if I engage in a class or use any equipment in any class, I do so entirely at my own risk. I agree that I am voluntarily participating in these classes and that I have obtained medical clearance to attend any classes and/or use any equipment involved.

Enter your full name here to confirm the above:

If you do not want us to use your data you may advise that you wish to withhold your consent when providing the information or you may do so by sending us an email to jhfitnessnotts@gmail.com at any time. Please refer to the privacy policy for more information.