PAR-Q (Adult)

Step 1/3

Your Details

Title (required)

First Name (required)

Surname (required)

Address 1 (required)

Address 2

Address 3

Town (required)

Country (required)

Postcode (required)

About You

Age (required)

Height (required)

Body Weight (required)

Contact Details

We require at least one telephone number.

Primary Contact Telephone No. (required)

Secondary Contact Telephone No.

Email (required)

Confirm Email (required)

In the case of emergency your contact person is:

Name (required)

Telephone No. (required)

Free Newsletter

We send out a monthly e-newsletter updating you with information about classes and news. Please tick if you do not wish to subscribe.

How did you hear about Jersey CrossFit?

I first heard about Jersey CrossFit from (required)

Please let us know your goal, event or reason for training

I am training for:

Step 2/3

Nearly there

Fitness

How often do you train? (required)

When was the last time you regularly trained? (required)

How would you describe your current fitness level (required)
UnfitReturning to fitness trainingFitVery Fit

Current & Past Training (required)

Step 3/3

The last few questions…

Health

Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly: check YES or NO.

Has your doctor advised you that you should not do any physical exercise or training (required)
YesNo

Are you post natal? (required)
YesNo

Do you suffer from asthma, or breathing difficulties? (required)
YesNo

Have you been in hospital in the last 3 years? (required)
YesNo

Are you taking any medication? (required)
YesNo

Do you suffer from diabetes or epilepsy? (required)
YesNo

Do you suffer from an allergy? (required)
YesNo

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

Do you feel pain in your chest when you do physical activity? (required)
YesNo

In the past month, have you had chest pain when you were not doing physical activity? (required)
YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness? (required)
YesNo

Do you have a bone or joint problem that could be made worse by a change in your physical activity? (required)
YesNo

Is your doctor currently prescribing drugs (ex. water pills) for your blood pressure or heart condition? (required)
YesNo

Do you know of any other reason why you should not do physical activity? (required)
YesNo

If you answered yes to any of the above questions , please provide more information:

If you answered:

Yes to one or more questions

  • Talk with your doctor by phone or in person before you start becoming much more physically active and before you start training. Tell your doctor about the PAR-Q, your intended training and which question(s) you answered YES.
  • You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advise.

No to all questions

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

  • Start becoming more physically active – begin slowly and build up gradually. This is the safest and easiest way to go..
  • Take part in an exploratory session to use as a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

  • If you are not feeling well because of a temporary illness such as a cold or fever – wait until you feel better.
  • If you are pregnant – talk to your doctor before you start becoming more active.
  • If your health changes so that you then answer YES to any of the above questions, consult your doctor. Similarly, if at any stage your details change, then it is your responsibility to complete a new PAR-Q form.

Membership Terms and Conditions

Disclaimer

Please read the following documents before proceeding with your booking:

  • The full Disclaimer which includes ‘Risk Factors’ click here.
  • The Membership Full Terms and Conditions click here.

I understand that participation in training activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding or can even lead to death. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct.(required)

This form has been completed accurately to the best of my knowledge and belief.(required)

I have read, understood and completed this form and by ticking this box I agree to be bound by its conditions.(required)

I have read and agree to the Membership Full Terms and Conditions & Disclaimer(required)

All participants must be over 18 years-old. We reserve the right to refuse participation if details on your PAR-Q Form suggest that their is a risk or possible risk to your health. HIIT Fitness Jersey Limited have the right to refuse participation for any reason without having to disclose its decision.

Electronic Signature Consent (required)

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.(required)

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