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Physical Activity Readiness

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To be completed for each parent/carer AND child taking part.  Parent/carer to complete form for children under 18 years and sign on their behalf.
Please complete date of birth DD/MM/YYYY or use the calendar symbol
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions on the next page. The PAR-Q will tell you if you should check with your doctor before you start. If you are over 70 years of age and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: select YES or NO.
Has your doctor ever said you have a heart condition?
Do you feel pain in your chest when you do physical activity?
In the past month have you had a pain in your chest when you were NOT doing physical activity?
Have you ever been told that your blood pressure was too high?
Do you lose your balance because you feel faint or have severe dizziness?
Do you suffer from back ache or aching joints that could be made worse by a change in your physical activity?
Do you suffer from or have any of the following?
If you answered YES to one or more of the questions talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions 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 advice.
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go. Take part in 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. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.
DELAY BECOMING MUCH MORE ACTIVE: If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or If you are or may be pregnant – talk to your doctor before you start becoming more active.
Do you suffer from or have any of the following?
Do you currently take any medication?
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. Your information will be kept securely in accordance with the provision of the General Data Protection Regulations 2018 which allows for sensitive personal data to be held where necessary to monitor Equal Opportunities Policy. Please refer to the relevant service privacy notice for details of when and how your information will be shared. You can view detailed privacy notices for all Health Improvement Services here: . Information may also be shared if anyone is at risk, and information will only be disclosed under common law “Duty of Confidence” without consent. Anyone receiving such information is under a legal obligation to keep it confidential.

Data Protection

Halton Borough Council is the Data Controller for the personal information you provide. We collect and hold information about you in order to process your booking. For further information regarding data protection please visit our Data Protection and FOI web page