Active Communities PARQ_Intro to Fitness

Pre Activity Readiness Questionnaire

Please complete the follow questions in order to register for your activity. This information will be stored securely under our GDPR policy.

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* 1. Name of young person registering:

Full name

Address

Town

Postcode

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* 2. Date of Birth:

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* 3. Emergency contact name:

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* 4. Emergency contact number:

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* 5. Please list any medical conditions or anything that we should be aware of:

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* 6. If you/your young person has a disability, please specify:

No

Yes (please specify)

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* 7. Parent/Guardian Email Address (if Under 16):

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* 8. If Under 16 - I consent to my young person taking part in this activity (print parent name):

Yes

No

Print Parent/Guardian Name

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* 9. I consent to having my photo taken for programme promotion purposes (print parent name if Under 16):

Yes

No

Print Parent/Guardian Name:

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* 10. Please select which session you are registering for:

4:00-4:45pm

5:00-5:45pm