Kids ParQ Form | Maka Pole & Fitness

Maka Pole & Fitness Child ParQ form

Parent/ Guardian Name

Child Name

Date of birth (DD/MM/YYYY)

Phone Number

How did you hear about us?

Emergancy Contact Name / Number

Health Questions

If you have ever had any of the following, please select 'yes'

Heart conditions or chest pain
High or low blood pressure
Faintness or dizzy spells
Asthma
Diabetes
Are you pregnant or postnatal
Have you had any operations in the last year
Any recent injuries
Bone or joint problems
Prescribed medicines or dietary supplements
Any other medical conditions not previously mentioned

If you have answered yes to any of the above questions, please provide further detail below. We would also recommend that you seek advice and confirmation from your doctor prior to participating in the class.

Photography Consent

To comply with GDPR, your permission is required before we can take any photographs or recordings of you/your child.

Health Declaration

Yes

Please tick the appropriate boxes below if you are happy for us to use photographs of you/ your child for promotional purposes:

In our own printed publications

On our website and app

On our social media?

I have read and understood theterms and conditions

I would like opt out of the mailing list

Thanks for submitting! This has now been sent to our team ready for your first class.

Maka Pole & Fitness Child ParQ form

Health Questions

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If you have ever had any of the following, please select 'yes'