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Step up to wellbeing form

If you’d like to take part in the Step up to Wellbeing sessions, please complete the Par-Q form below. Anyone who wants to take part in the session, including anyone you bring with you must complete the form.

Once the form has been completed it will be processed as being confidential, and you will receive a confirmation email. You will not be able to participate without completing the form. 

  • PAR-Q form
    PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose any problems or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. If you are considering increasing the amount of physical activity you do on a regular basis, then please complete the below form.
  • Name
  • Common sense is your best guide in answering these few questions. Please read the carefully and check YES or NO opposite the question if it applies to you. If yes, please explain.
  • 1. Has your doctor ever said you have heart trouble?
  • 2. Do you frequently have pains in your heart and chest?
  • 3. Do you often feel faint or have spells of severe dizziness?
  • 4. Has a doctor ever said your blood pressure was too high?
  • 5. Has your doctor ever told you that you have a bone or joint problem(s) such as arthritis that has been aggravated by exercise, or might be made worse with exercise?
  • 6. Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you wanted to?
  • 7. Are you or have you been pregnant in the last 6 months?
  • 8. Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?
  • 9. Are you currently taking any medications?
  • 10. Do you currently have a disability or a communicable disease? The Disability Discrimination Act 1995 defines a disabled person as anyone with ‘physical or mental impairment that has a substantial and long-term adverse effect upon his/hers ability to carry out normal day-to-day activities'.
  • 11. Do you currently have a temporary illness such as a flu or cold?
  • 12. Have you recently experienced blackouts or fainting?
  • If you answered NO to all questions above, it gives a general indication that you may participate in physical and aerobic fitness activities. The fact that you answered NO to the above questions, is no guarantee that you will have a normal response to exercise. If you answered Yes to any of the above questions, then you may need written permission from a physician before participating in physical and aerobic fitness activities.
  • I confirm that the information given is a true and accurate statement. I understand that it is my responsibility to ensure that I am fit and able to increase any physical activity currently undertaken and that I fully understand that if I have declared any of the conditions listed, that I should seek medical advice before increasing my physical activity. I agree that any decision to take part in Solent University organised events that require some form of physical activity are by my own decision and that I fully understand the implications of doing so.
  • It is Southampton Solent University‘s policy not to release your personal data to third parties unless; you have given your explicit consent, there is a legal or academic requirement to do so, or for the purpose of the University’s debt recovery. It is normal University practice to use photographs and video footage of students to promote best practice on its internal and external publications, including the internet. The University also uses external agencies to assist with its marketing processes. If you have any objections to this please contact the Student Achievement Team via email: Student.Achievement@solent.ac.uk. Solent University is not responsible for any damage, or loss caused by participation in a physical fitness programme, or leisure activity. If you require other assistance please inform our staff.

 

Page last updated on Wednesday 21 November 2018 at 10.47am.

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