Group: Ballers Academy
When using this form, you should:
Understand why you are submitting this information.
What your coach(s) are going to do with this information.
Your coach(s) policy for destroying this information (within a period of time or once you as a client has left).
PAR-Q - Short Version
Introduction
If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Please read each question carefully and answer honestly by indicating YES or NO.
Confirm details
If you answered YES to one or more questions:
You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.
If you answered No to any of the questions:
It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.
Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.
PAR-Q - Short Version
Consent
This consent should be given by the participant or an adult/guardian. If under the age of 13 consent must by given by whoever holds parental responsibility for the child.
I understand that the submission of this information is voluntary and I consent for all of the information provided to be shared with and viewed by my organisation (including it’s staff), and being stored by Proactive Reporting for the purpose of providing the recognised service(s) provided by my organisation (Most regularly fitness, leisure, personal training, or class based exercise), and I understand how my data will be used. Full details here
Please confirm you understand how your data will be used.
The information we collect is voluntarily given by yourself and will be provided to your organisation to view and act upon - your organisation controls your data. Proactive Reporting will not share your data with any other party and is responsible only for the storage of this data in line with our Privacy Policy available at proactivereporting.com
We will store the data collected for your organisation for a period up to 7 years or until we are instructed to remove it by your organisation. If you would like your information removed please contact your organisation and they will inform us.
We respect your trust and protect your privacy, and therefore will never sell or share your data with any third parties.
If you have any questions or are concerned about how your organisation is using your data then please contact us at proactive@we-activate.co.uk
Special Category Data – Health (Health related information, diet and nutrition, lifestyle, exercise relevant medical history, symptom related questions, structural health)
I understand that the submission of this information is voluntary, and I consent for all of the information to be shared with and viewed by my organisation (including it’s staff), in order for my organisation to advise me on whether the participant named should or should not commence/take part in physical activity and to help prescribe suitable and relevant activity levels and type. Full details here
Please confirm you understand how your data will be shared / viewed.
Special Category Data – Health (Health related information, diet and nutrition, lifestyle, exercise relevant medical history, symptom related questions, structural health)
Your organisation (identified by the person who sent you your PAR-Q for completion) has signed up to the use of this form and system provided by Proactive Reporting, part of Activate Management Ltd (Registered address 17a Arden Business Centre, Arden Forest Industrial Park, Tything Road, Alcester, B49 6HW).
The information collected includes information included in the “Special categories of personal data” as specified within the ‘General Data Protection Regulation (GDPR)’. Including the request for health and medical information about you as detailed above.
As such your organisation requires a lawful basis under Article 6 of the GDPR and a separate condition for processing under Article 9.
In this instance the ‘lawful basis’ under Article 6 of GDPR is – Consent and in this instance the ‘separate condition’ for processing under Article 9 is – Explicit Consent
Purpose of processing – The processing of your personal data is designed to provide your organisation with information related to the suitability of individuals to take part in activities or to visit certain facilities. The processing is also designed to facilitate your organisations ability to prescribe exercise or activity according to their qualifications to do so.
The completion of this form is completely voluntary and you do not have to complete it for your organisation. You may opt out of completing this form and provide your organisation with an alternative method of self-assessment. If you are opting out please do not submit this form, instead you should contact your organisation to identify an alternative method.
Your organisation may only use this information for the purposes that they identify with you (Normally to assess the suitability to commence exercising or physical activity, or to contribute to the prescription of specific activity levels or types.), and in the event that they are required to provide information to outside organisations as a legal requirement (for example in the event of an insurance claim).
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.
PAR-Q - Full Version
Your health goals:
What are your main reasons for starting a fitness programme?
PAR-Q - Full Version
What would you say are the main barriers preventing you from exercising?
PAR-Q - Full Version
Diet and Nutrition
Do you follow any particular diet or eating patterns?
Lifestyle
PAR-Q - Full Version
Medical History
Please indicate if you ever experience any of the following symptoms. Do you:
Having completed this questionnaire (or on the advice of my coach) I have sought medical advice and my GP has agreed that I may exercise.
PAR-Q - Full Version
Structural Health
Please indicate on the figures below any aches, pains or problem areas
Front of body
Back of body
Please give details of any areas indicated
Please indicate any other health problems you suffer from which you have not already mentioned.
PAR-Q - Full Version
Consent
This consent should be given by the participant or an adult/guardian. If under the age of 13 consent must by given by whoever holds parental responsibility for the child.
I understand that the submission of this information is voluntary and I consent for all of the information provided to be shared with and viewed by my organisation (including it’s staff), and being stored by Proactive Reporting for the purpose of providing the recognised service(s) provided by my organisation (Most regularly fitness, leisure, personal training, or class based exercise), and I understand how my data will be used. Full details here
Please confirm you understand how your data will be used.
Special Category Data – Health (Health related information, diet and nutrition, lifestyle, exercise relevant medical history, symptom related questions, structural health)
I understand that the submission of this information is voluntary, and I consent for all of the information to be shared with and viewed by my organisation (including it’s staff), in order for my organisation to advise me on whether the participant named should or should not commence/take part in physical activity and to help prescribe suitable and relevant activity levels and type. Full details here
Please confirm you understand how your data will be shared / viewed.
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a level of risk.