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Pre-Activity Readiness Questionnaire (PAR Q)

PAR-Q

Pre-Activity Readiness Questionnaire

Pre-Activity Readiness Questionnaire

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YOUR PERSONAL DETAILS

First name:

Last name:

Email:

Phone number:

Date of birth:

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EMERGENCY CONTACT DETAILS

Emergency contact first name:

Emergency contact last name:

Emergency contact phone number:

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MEDICAL QUESTIONS

Have you practiced Yoga before?

Do any of the following conditions apply to you? (Select all that apply)

High blood pressure

Low blood pressure

Fainting

Arthritis

Diabetes

Epilepsy

Heart problems

Asthma

Depression

Detached retina/other eye problems

Recent injury

Recent operation

Back problems

Knee problems

Neck problems

Recent/Current Pregnancy

If you answered yes to any of the conditions above, please give further details:

Do you have any other conditions, which affect your mobility or are likely to cause you concern when doing Yoga?

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DISCLAIMERS

Opt-In

I agree to take full responsibility for my health including any injuries during the participation in any activity provided by Love More Yoga and that of any participants I book on behalf of, whether that be to participate online or in person. I confirm that all the information above is true and accurate to the best of my knowledge and I will inform my Yoga teacher of any medical and/or contact detail changes. I voluntary agree to release any liability from Love More Yoga in the result of any injury or damages that I may sustain.

Opt-In

By checking, I agree to share my form responses with Love More Yoga.

Thank you for submitting your PAR-Q form!

In completing this form you are helping to decide whether Yoga is safe for you.

If you have any questions, please reach out to hello@lovemoreyoga.co.uk

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Joanna at Love More Yoga

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