PARQ Form : Rochdale Harriers & A.C.

PARQ Form for Rochdale Harriers & A.C.

Following UK Athletics Guidelines, we need to check for any major health issues before you begin training with us. Please complete this PARQ Form and send it to us before attending our training sessions. The completed Form will be kept confidential in line with the Privacy Policies of UKA and Rochdale Harriers & A.C. If you are completing this form on behalf of a Junior, please include the Junior's details below but use your contact details.

Date *

Prefix

First Name *

Last Name *

Email Address *

Age *

Date of Birth *

Phone Number *

Regular exercise is associated with many health benefits, yet any change of activity may increase the risk of injury. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life.

Please read each question carefully and answer every question honestly:

1. Do you have any pre-existing medical conditions? *YesNo

2. Do you have a respiratory condition? *YesNo

3. When doing physical activity, do you experience any pain or tightness in your chest? *YesNo

4. Do you ever lose balance or consciousness because of dizziness or light headedness? *YesNo

5. Do you have any joint or bone condition or problem? *YesNo

6. Are you pregnant or post-partum? (if so you will need to complete a separate PARQ form for expectant and new mums) *YesNo

7. Are you completing this form on behalf of a junior? *YesNo

You answered "Yes" to one of questions 1 to 6 above. Please provide more information, in strictest confidence, in the box below or call our Lead Welfare Officer to discuss.

Please incluide your full name and your relationship to the Junior applicant in the text box below.

PARQ Form

PARQ Form for Rochdale Harriers & A.C.

Regular exercise is associated with many health benefits, yet any change of activity may increase the risk of injury. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life.

Please read each question carefully and answer every question honestly:

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