Youth PAR-QGym PAR-Q – YouthYou need to fill this in every year, so we have up-to-date medical information on your fitness to use the gym and can provide appropriate advice.Step 1 of 250%Your childName of child* First Last Date of birth* Day Month YearCurrent ageMedical questionsPlease answer the following questions on behalf of your child. Before they significantly change their exercise patterns, please check with your doctor.Has your Doctor ever said you have a heart condition and that you should only do physical activity recommended by a Doctor?* Yes NoDo you feel pain in your chest when you do physical activity?* Yes NoIn the past month, have you had a chest pain when you were not doing physical activity?* Yes NoDo you lose balance because of dizziness or do you ever lose consciousness?* Yes NoDo you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in your physical activity?* Yes NoIs your Doctor currently prescribing medication for your blood pressure or a heart condition?* Yes NoDo you know of any other reason why you should not do physical activity?* Yes NoAre you usually inactive, doing very little exercise? Yes NoHave you checked with your Doctor that it is safe for you to become physically active at this current time and in your current state of health?* Yes NoIt might not be safe for us to induct you at the momentPlease consult your Doctor to clarify if it is safe for you to become physically active at this current time and in your current state of health. Then if your Doctor says yes, please fill in this form again and we will arrange an induction. If you want to discuss this, please contact us at gym@penistoneleisurecentre.org.uk.We can arrange for an induction for youIt is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.We can arrange for an induction for youIt is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.Conditions of UsePlease agree to the below:I have read, understood and accurately completed this questionnaire* YesI confirm that my child is voluntarily engaging in an acceptable level of exercise and their participation involves a risk of injury. They are responsible for their own safety and wellbeing.* YesI agree that disruptive / anti-social / illegal behaviour, or behaviour impacting on other centre users may result in my child being asked to leave.* YesI agree to this information being collected to allow Sporting Penistone to meet its insurance and legal requirements and to provide a safe sport environment* YesI agree to this data being held in my online Penistone Leisure Centre account until I cease to be a member. I know it can be accessed by the coach and admin staff while managing my account. YesParent / GuardianParent / Guardian name* First Last Parent / Guardian email Parent / Guardian phone no*For emergency contactAs parent / guardian of the child, I have checked that the above questions have been answered correctly to the best of my knowledge. I agree to all the conditions above and give permission for my child to attend the class.* YesΔ
