Please complete this form and details for payment will follow:

PARQ form
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Name:
Are you currently pregnant?
If you answered 'Yes', on receipt of this form I will email across a pregnancy specific PARQ
Are you currently breastfeeding?
If you answered 'Yes', on receipt of this form I will email across some breastfeeding specific guidance
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (for example, back, hip or knee) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions?
Do you know of any other reason why you should not do physical activity?
Have you been advised not to exercise by your doctor/midwife following your postnatal check?
Have you experienced any complications during pregnancy/birth/or postpartum?
If you answered YES to one or more question: Talk with your doctor/midwife in person or on the phone before becoming much more physically active. Tell your doctor about the PAR-Q and which questions you answered yes to. - You may be able to do any activity you want as long as you start slowly and build up gradually - You may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice If you answered NO honestly to all PAR-Q questions you can be reasonably sure that you can start becoming much more physically active by beginning slowly and building up gradually.
Do you give consent for photos you share to be used for Fit with Mum social media pages?
Would you like to be added to a 'Fit With Mum' WhatsApp group, for support and to connect with other mums?
Please select membership:
Your membership will commence from the date of the first class following receipt of payment
Note: this physical activity clearance is valid for a maximum of 12 months from the date it is completed. Please inform me immediately if there is a change in your condition which would affect any of your responses.
Confirmation of booking will be sent once payment has been received.