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Covid-19 Health Declaration

How are you feeling today?

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.

Thanks for submitting!

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