Jo Roberts Pilates

Pilates Body Mind & Soul

Studio classes in Northwood & live online

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Personal details and Physical Activity Readiness Questionnaire (PARQ)

Please refer to the Data Protection section of our Privacy Policy for details of why we are collecting this data and how we use and protect it.

Please refer to the COVID-19 Notice for the latest information in respect of the impact on classes.

If you are between the ages of 15 and 69, this PAR-Q form will tell you if you should check with your doctor before you significantly change you physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.
Please read each question carefully and answer honestly by indicating YES or NO.

By submitting this form you are providing a digital signature of your understanding and acceptance of its contents.

Full name*

Street address*

Post code*

Email*

Phone no. (for emergencies only)

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?*

Do you feel pain in your chest when you do physical activity?*

In the past month, have you had a chest pain when you were not doing physical activity?*

Do you lose balance because of dizziness or do you ever lose consciousness?*

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

Is your doctor currently prescribing medication for your blood pressure or heart condition?*

Do you know of any other reason why you should not take part in physical activity?*

If you answered Yes to any of the above questions please give further details.

I accept that attending a studio-based class while the COVID-19 virus remains a threat will be entirely at my own risk. (Please read the COVID-19 information page for more details)*

I confirm that I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise and understand that my participation involves a risk of injury.*

Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.

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