Prior to participating in our dance fitness classes, you are required to complete this Physical Activity Readiness Questionnaire (PAR-Q). I am required by law, to obtain details of your medical history to ensure our SOSA Dance Fitness sessions are compliant and suitable for your needs.
Please be completely open and honest about your medical history, physical and mental wellbeing at this time. I am committed to ensuring that your health and wellbeing is at the forefront of my priority at this time, and under GDPR regulations, all information you share with me as a professional health and fitness professional, will be treated with the strictest confidentiality.
Please complete the questionnaire below and tick the response that applies to you. All questions automatically default to 'No', so please read carefully and change to 'Yes' if they apply. You are wholly responsible for your answers and if you are in any doubt, then please contact me directly to discuss further, or seek professional medical advice from your GP.
Are you taking any prescribed medication?
Do you have any allergies?
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?
Do you suffer with high or low blood pressure?
Has your doctor ever said you have raised cholesterol?
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Have you ever felt pain in your chest when you do physical exercise or at rest?
Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
Is there any history of coronary heart disease in your family?
Do you often feel faint, have spells of severe dizziness or have you ever lost consciousness?
Do you suffer from regular headaches, dizziness, fainting or fits?
Do you know of any other reason why you should not participate in a programme of physical activity?
Have you received your COVID vaccination?
First vaccineBoth vaccinesNone
Have you contracted COVID? If so, do you have any lasting effects of Long-COVID?
Are you currently, or have you, experienced anxiety, depression, social isolation or fears of returning to a social/group environment due to lockdown?
Do you have any long-term health conditions or disabilities we should know about?
If you have any further information you wish to share regarding your health and/or mental wellbeing at this time, 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 email@example.com. 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
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
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