Please provide an Emergency Contact Name, Relationship & Phone Number:-

​Physical Activity Readiness Questionnaire (PAR-Q)​

​

• Has your doctor ever said you have heart Trouble?                       

• Do you frequently have pains in your chest?                                  

• Do you often feel faint or have spells of severe dizziness              

• Has your doctor ever said your blood pressure was too high      

• Has your doctor ever told you that you have bone or joint problem(s) such as? Arthritis that has been aggravated by exercise, or might be made worse with exercise

• Do you suffer from any problems to the lower back, i.e., Chronic pain, or numbness

• Do you currently have a disability or a communicable Disease

• Are you suffering with any form of Cold or Flu Symptoms, If so please do not attend classes until symptoms have subsided?

• Are you suffering with any of the Corona Virus Symptoms, if so please refrain from joining classes until you have received the all clear from the doctor?

​

If you answered NO to all the questions above, it gives a general indication that you may participate in Line dancing classes. The fact you answered NO to the above questions, is no guarantee that you will have a normal response to exercise. If you answered YES to any of the above questions, then I suggest seeing your doctor before participating in Classes. This is just a suggestion for your own well-being.

​

By hitting the green submit Button I confirm that I have answered No to all the questions in the PARQ section of this health questionnaire and I confirm that I undertake Linedancing at my own risk.