Royal KidsPhysical Activity Readiness Questionnaire (PAR-Q) Childs Name * First Name Last Name Parent/Guardian Name * First Name Last Name Parent/Guardian Contact Number * (###) ### #### Parent/Guardian Email * Relationship to Child * Childs Date of Birth * Childs Current Age * Prior to participating in Royal Jiu Jitsu classes you are required to complete this PAR-Q on behalf of your child. For most children, physical activity should not pose any problem or hazard, however, potential risks, whilst not apparent at rest, may be exacerbated by an increase in levels of physical activity. The PAR-Q is designed to identify those children for whom physical activity might be inappropriate or those who should seek medical advice concerning the type of activity most suitable for them. Please complete the questionnaire below by reading each question carefully and inserting a cross against the response that applies to your child. You are wholly responsible for your answers and if you are in any doubt you must seek medical advice. Does your child have, or have they ever experienced any of the following? High or low blood pressure? Elevated blood cholesterol? Diabetes or any other metabolic disease? Chest pains either at rest of brought on by physical exertion? Childhood epilepsy? Regular headaches, dizziness or fainting? Bone, joint or muscular problems with arthritis? Asthma or other respiratory conditions? Any sustained injuries or illness? Any allergies? Is your child taking any medication? Has your doctor ever advised your child to not exercise? Do you know any other reason why your child should not participate in physical activity? Is there any further information you feel the coach should be aware of? If you answered 'yes' to one or more of the questions, please write full details here: You acknowledge that you are taking responsibility for the accuracy of your replies and the decision that your child is physically fit enough for unrestricted physical activity with us. By signing this PAR-Q, I the parent/guardian of the aforementioned child have read this form in its entirety and have answered the questions accurately and to the best of my knowledge. I understand that my child is responsible for monitoring themselves throughout any activity, and should any unusual symptoms occur, would cease participation and inform the instructor. In the event that medical clearance must be obtained prior to my child’s participation in an exercise session, I agree to contact the GP and obtain written permission prior to the commencement of the exercise activity, and that this permission be given to Royal Jiu Jitsu. I understand that if my child fails to behave in a manner that is polite and social, he/she could be suspended from that activity or future activities. * Yes No Data Consent * Please confirm that you are happy for your child to have photos and training videos during class for advertising purposes, including social media. Yes No I have read and understood the Terms and Conditions * Yes No Date * MM DD YYYY Name * Thank you for your time in completing this questionnaire, we look forward to welcoming your child onto the mats at Royal Jiu Jitsu!
