#MileShyClub Membership Form and Medical Questionnaire (PAR-Q)

Many health benefits are associated with regular exercise, and the completion of PAR-Q (Physical Activity Readiness Questionnaire) is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose any problem or hazard. PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the best guide in answering these few questions. Please read them carefully and answer ‘Yes’ or ‘No’ to the questions below.

Which #MileShyClub location are you normally based at?
Name *
Emergency contact name *
Emergency contact name
Who can we contact on the day in the event you become unwell.
A number for your emergency contact
Has your doctor ever said that you have a heart condition and that you should only do physical activity when recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had a chest pain when you were not doing physical activity? *
Do you lose balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing you drugs (for example, water pills) for your blood pressure or heart? *
Do you know any other reason why you should not do physical activity? *
At the #MileShyClub, we occasionally take photos to promote the work of the charity. If you do not want to be photographed, please check this box