Self Defence Class – Health & Registration Form

Thank you for booking. We are looking forward to meeting you and we hope you will enjoy the class. Please make sure you have the date booked in your diary.

Please take a few minutes to fill in and submit the following Health & Registration Form and you’re ready to go.

Each person participating must fill in a form. If the applicant is under 18 years of age, this form must be signed by a parent or guardian.

This class is suitable for 12 years of age and above.

Furthermore we respect your privacy. The information submitted will not be shared. Thanks and see you soon, don’t forget to book the date in your calendar.

APPLICANT’S DETAILS

 

 

CONTACT DETAILS

We require at least one telephone number.

In the case of emergency your contact person is:

 

PAR-Q (Physical Activity Readiness Questionnaire)

If you answered:

Yes to one or more questions

  • Talk with your doctor by phone or in person before you start becoming much more physically active and before you start training. Tell your doctor about the PAR-Q, your intended training and which question(s) you answered YES.
  • You may be able to do any activity you want as long as you start slowly and build up gradually. Or, 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 advise.

No to all questions

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

  • Start becoming more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
  • Take part in an exploratory session to use as a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

  • If you are not feeling well because of a temporary illness such as a cold or fever – wait until you feel better.
  • If you are pregnant – talk to your doctor before you start becoming more active.
  • If your health changes so that you then answer YES to any of the above questions, consult your doctor. Similarly, if at any stage your details change, then it is your responsibility to complete a new PAR-Q Form.

Disclaimer

Please read the following documents before proceeding:

If under 18 years of age this form must be signed by a parent or guardian

Thank you for completing your Health Form.

PLEASE PRESS THE BUTTON BELOW TO SUBMIT