Physical Activity Readiness Questionnaire 

Prior to participating in our upcoming event, we need you to complete a Physical Activity Readiness Questionnaire.

For most people, physical activity should not pose any problem or hazard, however, potential risks, whilst not apparent at rest, may be exacerbated by an increase in levels of physical activity.

This questionnaire is designed to identify the small number of participants for whom physical activity might be inappropriate, so please could you just take a few minutes to complete the questions below by carefully reading each  question and selecting the appropriate answer.

You are wholly responsible for your answers and if you are in any doubt you should seek medical advice with your GP before continuing to register for this event.

    Prior to participating in our fitness classes, you are required to complete this Physical Activity Readiness Questionnaire (PAR-Q). Potential risks, whilst not apparent at rest, may be exacerbated by an increase in levels of physical activity. The PAR-Q is designed to identify those who should seek medical advice concerning the type of activity that is most suitable for them. Please complete the questionnaire below by reading each question carefully and ticking the response that applies to you. You are wholly responsible for your answers and if you are in any doubt you must seek medical advice. We are requited by law to obtain details of your medical history to ensure our Seated SOSA Dance Fitness sessions are suitable for you to take part in.

    Are you taking any prescribed medication?

    NoYes

    Do you have any allergies?

    NoYes

    Has your doctor ever said that you have a bone or joint problem, such as arthritis, or any medical condition, surgical operation or injury that has been aggravated by exercise or might be made worse with exercise?

    NoYes

    Do you suffer with high or low blood pressure?

    NoYes

    NoYes

    Has your doctor ever said you have raised cholesterol?

    NoYes

    Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

    NoYes

    Have you ever felt pain in your chest when you do physical exercise or at rest?

    NoYes

    Have you ever suffered from unusual shortness of breath at rest or with mild exertion?

    NoYes

    Is there any history of coronary heart disease in your family?

    NoYes

    Do you often feel faint, have spells of severe dizziness or have you ever lost consciousness?

    NoYes

    Do you suffer from regular headaches, dizziness, fainting or fits?

    NoYes

    Do you know of any other reason why you should not participate in a programme of physical activity?

    NoYes

    Do you have any long-term health conditions or disabilities we should know about?

    If you answered ‘Yes’ to one or more questions, please provide more details below

    Special Considerations - We are committed to ensuring that dance classes are tailored to your individual learning and physical needs. So that we may necessitate adjustments or additions to our sessions, please provide any information we should be aware of, including any lasting injuries?

    Informed Consent - Our programme is designed to improve cardiovascular fitness (heart and lungs), muscle and core strength, endurance and flexibility. Our programme is designed to minimise the risk of injury, however, if at any time during the exercise programme you feel pain, discomfort or you feel unwell you must stop immediately. Each step of the programme will be fully explained to you, but please notify us if you feel you should not do a particular exercise for any reason or have any questions at all.

    Home Participation Disclaimer - If you are taking part in any online classes or routines via social media or video streaming platforms, you must ensure that you wear the appropriate footwork for the floor surface where you are dancing, and ensure you have sufficient room to move around without obstacles or trip hazards (including pets) in the way. Please also ensure you have enough space above you to perform raised arm movements, that the room is at an appropriate temperature with sufficient ventilation and you drink plenty of water throughout. SOSA Dance Ltd takes no responsibility for any injuries of accidents that may be sustained during the online participation of our classes in your home/workplace environment.

    I hereby confirm that I have read, understood and answered all the questions on the PAR-Q accurately and to the best of my knowledge. I have also read the informed consent and home participation disclaimer and take full responsibility to ensure my home environment is suitable for the exercise programme. If there are any changes to my health that may affect me during exercise, I will inform the programme provider immediately at seated@sosafitness.co.uk. I confirm that I wish to participate in this exercise programme and realise that the activities involve a small element of risk.

    Please tick here to say you have read, understood and agree with the above Informed Consent and Home Participation Disclaimer

    I agree

    For your information, by submitting this form you are giving us permission to contact you in accordance with the new data protection law (GDPR Compliance) May 2018. We take data protection very seriously and all data will be kept securely as per the recommendations and legislations set out by the GDPR, the ICO and data protection laws.

    Emergency Contact Details - Please provide the full name and telephone number for someone we could contact on your behalf in case of an emergency

    Your Full Name (required)

    Your Email Address (required)

    Your Telephone Number (required)

    Which company/organisation has given you access to this community project? (required)

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    Informed Consent 

    Exercise programmes are designed to improve cardiovascular (heart and lungs) fitness, muscle strength and endurance as well as flexibility. All exercise programmes contain certain risks such as muscle strains, joint sprains, aches, pains and general discomfort from parts of the body not used to exercise.

    The programme is designed to minimise these risks, however, if at any time during the day you feel pain, discomfort or you feel unwell you must stop and inform the a member of our team immediately. Please notify one of our team in advance if you feel you should not take part in a particular exercise or session for any reason.

    During certain dances we use maracas, please be aware of the people around you when using these maracas as SOSA Dance Fitness or members of our team cannot be held responsible for any damage to persons or property as a result of their use.

    Please confirm that you have read, understood and answered all the questions on the PARQ accurately and to the best of your knowledge.

    If you have answered ‘yes’ to any of the questions above, by agreeing to our terms and conditions below, you are also confirming that you have taken medical advice relating to your participation and your doctor has confirmed you are fit enough to participate.

    You confirm you are voluntarily engaging in a level of exercise that you consider acceptable and appropriate to your level of fitness.

    You confirm that you wish to participate in this dance event and realise that the activities involve an element of risk of injury.

    You confirm that you have read and understood the EMD UK Privacy Policy and consent to it’s contents.

    You give your consent for EMD UK to contact you to let you know about other group exercise activities/products/opportunities that they think you may be interested in.

    You grant SOSA Dance Ltd the right to use and reproduce any and all photographs, video clips, and/or audio clips taken of yourself in conjunction with the event taking place on Sunday 14th January 2018, and in any subsequent newsletters, brochures, websites, marketing and advertising materials including official social media platforms, publications such as newspapers, magazines and affiliate partner websites.

    You waive the right to inspect or approve the finished versions of such images including written copy that may be created in connection therewith.

    You understand that photos/audio/video used by SOSA Dance Ltd for the reasons stated above, are considered the property of SOSA Dance Ltd.

      Please tick here to say you have read, understood and agree with the above Informed Consent

      I agree

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