Physical Activity Readiness Questionnaire (PAR-Q)

Please complete the following questionnaire before your first session with Pump Pilates.

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This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email Address(Required)

Phone(Required)

Have you been notified as having a heart condition and that you should only do physical activity under medical advice?(Required)

Do you feel pain in your chest when you do physical activity?(Required)

In the past month, have you had chest pain when you were not doing physical activity?(Required)

Do you lose balance because of dizziness, or do you ever lose consciousness?(Required)

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?(Required)

Is your doctor currently prescribing you medication for blood pressure or a heart condition?(Required)

Are you pregnant or have you given birth in the last 6 months?(Required)

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

If you have answered "Yes" to any of the above, please provide further details here, including if the issue is current, a previous issue, or will affect your ability to exercise in this session.

Informed Consent(Required)

I hereby acknowledge that the nature of the exercise sessions that I am about to undertake have been fully explained. Whilst I am aware that every care will be taken by the tutor, I will participate at my own risk.

Waiver(Required)

I confirm that I acknowledge, understand and agree to the waiver.