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    PE - Draft Parq Form

    Uploaded by

    Yenny Tiga
    This document is a PARQ form for a young person's physical activity readiness questionnaire. It collects registration information for a young person like name, address, gender, and date of birth. It then asks a parent or guardian questions about the young person's health history and current conditions, focusing on any cardiac, respiratory, or musculoskeletal issues that could impact physical activity safety. A parent must declare the answers are correct to their knowledge and will inform coaches of any changes. The child also must abide by facility rules and staff instructions.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    PE - Draft Parq Form

    Uploaded by

    Yenny Tiga
    684 views2 pages
    This document is a PARQ form for a young person's physical activity readiness questionnaire. It collects registration information for a young person like name, address, gender, and date of birth. It then asks a parent or guardian questions about the young person's health history and current conditions, focusing on any cardiac, respiratory, or musculoskeletal issues that could impact physical activity safety. A parent must declare the answers are correct to their knowledge and will inform coaches of any changes. The child also must abide by facility rules and staff instructions.

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    This document is a PARQ form for a young person's physical activity readiness questionnaire. It collects registration information for a young person like name, address, gender, and date of birth. It then asks a parent or guardian questions about the young person's health history and current conditions, focusing on any cardiac, respiratory, or musculoskeletal issues that could impact physical activity safety. A parent must declare the answers are correct to their knowledge and will inform coaches of any changes. The child also must abide by facility rules and staff instructions.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    684 views2 pages

    PE - Draft Parq Form

    Uploaded by

    Yenny Tiga
    This document is a PARQ form for a young person's physical activity readiness questionnaire. It collects registration information for a young person like name, address, gender, and date of birth. It then asks a parent or guardian questions about the young person's health history and current conditions, focusing on any cardiac, respiratory, or musculoskeletal issues that could impact physical activity safety. A parent must declare the answers are correct to their knowledge and will inform coaches of any changes. The child also must abide by facility rules and staff instructions.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    PARQ FORM

    Young Person’s ‘Physical Activity Readiness’ Questionnaire

    Dear Parent / Guardian,

    There are many health benefits to be gained when children and young people exercise regularly. It is
    sensible however to consider their health status prior to commencing a physical exercise programme. This
    questionnaire aims to identify your child’s health status so that we can provide exercise advice and avoid any
    risk of injury or illness.

    Young Person’s Registration Information

    First Name: …………………………………………Surname: ……………………………………………..

    Address: ……………………………………………………………………………………………………….

    ………………………………………………………………………………………………………………….

    ……………………………………………………… Postcode: ……………………………………………

    Home No: ………………………………………… Mobile No: …………………………………………..

    Gender: Male / Female (please circle) Date of Birth: ………………………………………..

    The following questions relate to the health of the young person. Please read the questions carefully and
    provide a correct answer by circling Yes or No. Where necessary, please provide details.

    Details

    Has a doctor ever diagnosed your child with a


    Yes No
    heart condition?
    Has your child recently had chest pains during
    Yes No
    or after exercise?
    Does your child ever feel faint or have spells of
    Yes No
    severe dizziness?
    Is your child currently receiving treatment or
    Yes No
    medication for high blood pressure?
    Is your child currently receiving treatment or
    Yes No
    medication for any other condition?
    Has your child broken any bones in the past six
    Yes No
    months?
    Does your child suffer from any bone or joint
    Yes No
    problems which exercise may aggravate?
    Does your child suffer from epilepsy or chronic
    Yes No
    asthma?
    Is your child diabetic? If yes, is the diabetes
    Yes No
    type 1 or Type 2?
    Has your child undergone any recent surgery?
    Yes No
    Is there any other reason which has not been
    mentioned that may affect your child if they Yes No
    took part in physical activities?

    Continued Overleaf

    1
    It is important to note that if you have answered “YES” to any of the above questions, there may be
    restrictions on your child’s ability to participate in exercise programmes. If you are unsure of any of the
    information you have provided we strongly advise that you consult with your Doctor before allowing your
    child to begin any exercise programme.

    Parent / Guardian Declaration

    1. I confirm that the above answers are correct, at this point in time, to the best of my knowledge and
    belief.

    2. I will ensure that I inform the coach at once if any of the above information changes.

    3. I agree that my child will abide by the rules of Queen’s Sport and follow the instructions of staff at all
    times.

    Signature: ……………………………………………………………………………………

    Print Name …………………………………………………………………………………..

    Relationship to Child ………………………………………………………………………..

    Date……………………………………………………………………………………………

    Coaches Signature …………………………………………………………………………..

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