Physical Activity Readiness Questionnaire

Many health benefits are associated with regular exercise and the completion of this questionnaire is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people this should not pose a problem or a risk.

Please read the questions below carefully and click YES/NO to each question as it applies to you.

Do you have any of the following?

Please provide further details at the bottom of the form if you answer YES to a medical condition and provide details of medications which you are currently taking

Data Protection (GDPR) Act 2018
Please Tick the boxes to agree

Next of kin
In the event of an emergency I would wish the following person to be notified:


Before you start the class you must ensure:

  • YOU have checked the area where YOU are working and have made sure there are no obstacles or hazards
  • YOU are fit and well enough to complete the class and advised the Instructor of any medical conditions, which are not already declared (ParQ)
  • Any equipment used by the YOU is being used correctly, in line with the manufacturer’s guidelines.
  • YOU must be a UK resident and taking part within the UK

The Instructor accepts no liability for any accident or injury resulting from participating in activities if the above conditions have not been met.

By submitting this form your consent is given.

Irene Gibson

Pilates Instructor & Personal Trainer
75 Vicarage Road

M: 07802 418755

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