PAR-Q FORM

About This Form

This form is designed to help us understand your health, abilities, and support needs before beginning exercise or activities with us. It is important that the information you provide is accurate and complete, as it allows us to:

Keep you safe while participating.
Adapt programs and activities to suit your needs.
Provide the right level of support so you can enjoy and benefit from each session.

These questions are not here to exclude anyone. They are simply a way for us to gather the right information so we can include you in the safest and most supportive way possible.

Sometimes, based on your answers, we may ask to follow up with your GP, specialist, or allied health professional before you start. This is only to make sure we’re working together in your best interest and giving you the most positive experience we can.

First name

Last name

Phone

Address

Goals & Additional Information Section

Anything Else You’d Like Us to Know? This space is for anything extra you’d like to share. You can use it for goals, supports that help you, things you enjoy, or anything else that will help us support you in the best way.

The following questions are about your health and support needs.

☑️ Only tick the box if it applies to you.

If it does not apply, leave it blank.

Do you ever experience unexplained pains in your chest at rest or during physical activity?

Has your doctor ever told you that you have a heart condition, or have you ever suffered a stroke?

Do you ever feel faint, dizzy, or lose balance during physical activity?

Have you had an asthma attack requiring medical attention at any time in the last 12 months?

If you have diabetes (Type I or II), have you had trouble controlling your blood sugar in the last 3 months?

Do you have any other ongoing medical conditions (such as high blood pressure, epilepsy, chronic lung disease) that may make exercise unsafe without medical clearance?

Are you currently pregnant, or have you given birth in the last 12 months?

Have you had any injuries, surgeries, or musculoskeletal issues (e.g., joint, back, or bone problems) that might be made worse by exercise?

Are you currently taking any prescription medications that could affect your ability to exercise safely?

Do you know of any reason why you should not do physical activity?

Do you use any mobility aids (e.g., wheelchair, walker, prosthetics) that we should be aware of when planning exercise sessions?

Do you have any sensory considerations (vision, hearing, touch, or sensory sensitivities) that we should be mindful of?

Do you require support with communication, instructions, or understanding (e.g., simplified language, Auslan, AAC device)?

Do you experience seizures, spasms, or other neurological conditions that may occur during exercise?

Are there any behaviours, triggers, or calming strategies we should know to help create a safe and positive environment for you?

Anything Else You’d Like Us to Know?

Emergency Contact Section

Would you like us to contact a support worker, parent, or guardian in case of emergency? (Include field for name & number).

Name

Relationship

Phone number

Consent & Acknowledgment

Declaration

I confirm that the information provided in this form is true and correct to the best of my knowledge. I understand that:

If I answered “Yes” to any of the health risk questions, I should seek medical clearance before beginning or continuing an exercise program.

Participation in exercise involves inherent risks, and I agree to follow the safety advice of the trainer/facilitator.

I consent to participate in Slim Gym / FrieNDIS programs and activities.

I give consent for photos/videos of me to be taken and used for social media/marketing (optional).

I understand that I can withdraw this media consent at any time.

Was this form completed by the participant themselves?

Yes

No, completed on their behalf

If completed on their behalf, please provide:

Name of person completing form

Relationship to participant (parent, guardian, support worker, etc.)

Contact number

Signature / Digital Signature:

Signature

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