The Par Q Form Template UK is offered in various formats including PDF, Word, and Google Docs, featuring both editable and printable versions for your convenience.
Par Q Form Template UK Editable – PrintableSample
Physical Activity Readiness Questionnaire (PAR-Q) Template UK 1. Personal Information 2. Emergency Contact Information 3. Medical History 4. Physical Activity Readiness Questions 5. Lifestyle Information 6. Consent and Acknowledgment 7. Signature and Date
Have you experienced any of the following? (Please check all that apply)
PDF
WORD
Examples
[Full Name]
[Date of Birth]
[Address]
[Phone Number]
[Email]
[Name of Emergency Contact]
[Relationship]
[Emergency Contact Phone Number]
Please detail any pre-existing medical conditions:
[List of Medical Conditions]
Are you currently taking any medications?
[Yes/No]
If yes, please list: [List of Medications]
Do you have any injuries or health issues that could affect your ability to engage in physical activity?
[Yes/No]
If yes, please explain: [Explanation]
I confirm that the information provided is accurate and I consent to participate in physical activities under the guidance of [Provider’s Name].
______________________________
[Date]
[Full Name]
[Address]
[Phone Number]
[Email Address]
[Emergency Contact Full Name]
[Emergency Contact Relationship]
[Emergency Contact Phone]
Please list any past medical conditions or surgeries:
[List of Conditions/Surgeries]
Are you on any medication?
[Yes/No]
If yes, please specify:
[Medications]
Do you currently have any health issues that may limit your participation in exercise?
[Yes/No]
If yes, please explain: [Explanation]
I acknowledge that I have read this form and understand the information provided is correct. I give my consent to take part in the activities.
[Signature Line]
[Date]
Printable
