The Pride Gym

The Pride Gym

Physical Activity Readiness Questionaire (PARQ)

Name *

First

Last

Phone *

Date of Birth *//

Email *

Email

Confirm Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Exercise Goals *

Have you ever had or suffered from any of the following?

If you answered 'Yes' you must seek consent to train from your GP.

Are you pregnant? (Women only)

Emergency Contact *

First

Last

Please enter the details of the person to be contacted in case of emergency