PARQ - Physical Activity Readiness Questionnaire

The following information is needed for your safety. If you have any specific medical concerns or have an existing health condition it is best to consult with your GP before attending a class. You are responsible for disclosing all relevant information and keeping me updated about any changes. Your details will be kept confidential and shared only in the case of an emergency. All the information you disclose will be subject to my privacy policy.

Name(Required)

First Last

Address(Required)

(or where you will be attending online classes from if different - in case of emergency)

Street Address Address Line 2 City County / State / Region Post Code Country

Date of Birth(Required)

Contact telephone number(Required)

Email(Required)

Which pronouns do you use?

(e.g., he/him, she/her, they/them)

Have you done yoga before?

If so, when, for how long, what style?

Emergency Contact Information

This information is required for in case of an emergency at an in-person class or online.

Name(Required)

First Last

Emergency contact telephone number(Required)

Email(Required)

You and your medical history

Have you had a major injury in the last 5 years?(Required)

Yes

Details about any injuries

Please give more details about any injuries here:

Are you taking any prescribed medication?(Required)

Yes

Prefer not to say

Medication details

Please give details about any medication here:

Are you receiving treatment for any diagnosed medical conditions?(Required)

Yes

Medical treatment information

Please give details about any medical treatment

Have you had any recent operations?(Required)

Yes

Details about medical operations

Please give details about any operations here:

Please let me know if you are affected by any of the following:

Please tick any that apply, leave unselected if none apply.

Any other information

Is there anything else I might need to know about to help us work safely?

Please be aware that you are responsible for respecting your own limits and staying within them. The above information is used as a guideline to the limitations of your ability to take part in the classes.

How did you find out about this class?

Would you like to be added to Gideon's yoga email list to receive information about classes and events?(Required)

Yes