Physical Activity Readiness Questionnaire

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HIIT Fitness Training Physical Activity Readiness Questionnaire

You MUST complete this PAR-Q before taking part in any of HESA HIIT FITNESS fitness sessions. Please read all the questions carefully and answer honestly. Your information will be kept in the strictest confidence. This form must be completed and returned prior to participation in any physical exercise session.

Name *

Email *

Comment or Message

Have you ever been told by a doctor not to take participate in physical exercise? If YES, please detail in box below *

Yes
No

If YES to above, reason why a doctor has advised not to participate in physical exercise

Have you got any heart conditions? *

Yes
No

Have you had any chest pain while exercising in the past month? *

Yes
No

Are you taking any medication for a heart condition? *

Yes
No

If YES to the above, what medication are you taking?

Do you suffer from bone or joint issues? *

Yes
No

If YES to the above, please explain

In the past year, have you had any major illness or surgery? *

Yes
No

Have you ever been diagnosed with any of the following? *

Type 1 Diabetes
Type 2 Diabetes
Epilepsy
Asthma
Other (please detail below)
None

Other Illness / Surgery

Are you pregnant or recently had a baby? *

Yes
No

Do you ever lose your balance due to dizziness or lose consciousness? *

Yes
No

If you have answered YES to one or more of the above questions you may need to speak to your doctor before taking part in these HIIT & Fitness sessions . If anything else changes over time, changing any of the above to a YES, please inform your instructor. I have read, understood and completed this questionnaire. All questions were answered to my full satisfaction. *

I Agree

ONLINE sessions - I am taking part in all online fitness classes on zoom, live or on catch up at my own risk and consider myself physically fit, healthy and safe to participate. *

I Agree

Declaration: I understand that HESA HIIT FITNESS/ Amanda Croall strongly advise that if I have not participated in regular physical activity prior to beginning this activity I should seek advice from my doctor. I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercises such as running, jumping, lifting, resistance exercises (including but not limited to barbells, dumbbells, kettlebells and various weight training equipment) and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me, and that I should consult my doctor if I am suffering from any condition that might make physical activity injurious to my health. I understand the results of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation inside and outside of the sessions. I understand that photographs and videos may be used for promotional purposes and I agree for them to be used. I agree that HESA HIIT FITNESS / Amanda Croall shall not be liable or responsible for any injuries to me resulting from my participation in the fitness classes/ program (whether at home, in the studio, outdoors or in any corporate / commercial facility) and I expressly release and discharge HESA HIIT FITNESS and it's owners/ employees from all claims, actions, judgements and the like which I or my heirs may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program. * *

I Agree that I have read and agree to the statements above

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Highland Elite Sports Academy
Unit 1, Highland House
20 Longman Road
Inverness IV2 1RY

Tel: 07746 623514

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