PARQ Health Questionnaire

Parent/Guardian Name

Address

Contact Number

Your email

Child details

Date of Birth

Health Questions
Does your child have/has your child ever had any of the following?

High or low blood pressureElevated blood cholesterolDiabetesChest pains brought on by physical exertionChildhood epilepsyDizziness or faintingA bone, joint or muscular problems with arthritisAsthma or other respiratory problemsAny sustained injuries or illnessesAny allergies?Is your child taking any medication?Has your doctor ever advised your child not to exercise?Is there any reason not mentioned above why any type of physical activity may not be suitable for your child?Suffer from anxiety/stress?Have any other mental health issues that we need to know about in order for us to look after their wellbeing?None of the above

If you have answered yes to any of these questions, please provide details here

Does your child have any favourite hobbies?

Does your child participate in other physical activities out of school?
YesNo

If yes, please indicate activity/activities

Has your child participated in physical activity in the past?
YesNo

How motivated is your child to do physical activity on a scale of 1-10 (10 being most motivated)?
—Please choose an option—12345678910

I agree that the information provided above is correct to the best of my knowledge.

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