Pre or Post Natal Physical Activity Readiness Questionnaire

Please complete before attending a fitness class. You only need to do this once unless anything changes between bookings. If you are NOT pregnant or up to 12 months post partum please complete the general PARQ. You should always check with your doctor before significantly changing your physical activity patterns. You should also have your postnatal doctor sign off before joining an exercise class. This form will remain confidential.

First Name

Last Name

Email

Due date or baby date of birth

Did you do any exercise before your pregnancy? If yes please briefly describe

Did you do any exercise during your pregnancy? If yes please briefly describe

Do you have a pre-existing medical condition?

Yes

No

Do you know of any other reason why you should not take part in physical activity?

Yes

No

If you answered yes to either of the previous questions please provide more information

If you answered YES to one or more questions: You must consult with your doctor to clarify that it is safe for you to join in with physical activities at this current time and in your current state of health

Are you currently breastfeeding?

Yes

No

If you are post partum have you had your postnatal doctor sign off?

Yes

No

Not Applicable

I declare that I have answered this form fully and honestly. I take part in any activity entirely at my own risk and where necessary I have consulted with my doctor before participating.

I understand that any form of exercise could lead to injury. I can ask my instructor any questions and can stop participating at any time. I understand that my instructor cannot give medical advice.

I understand that if I am bringing a dependant to a class then I am fully responsible for them at all times.

If someone has offered you their space on the class while they are on holiday or unable to come one week (i.e you have not completed the booking form for yourself) please provide emergency contact details (name and phone number).

Your Signature

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Pre or Post Natal Physical Activity Readiness Questionnaire

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