German Instructor Training PAR-Q Form

First name

Last name

Email

Country/Location

Social Media Handles

Do you have any additional learner needs?

Yes

No

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

No

Do you feel pain in your chest when you do physical activity?

Yes

No

In the past month, have you had chest pain when you were not doing physical activity?

Yes

No

Do you lose balance because of dizziness or do you ever lose consciousness?

Yes

No

Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?

Yes

No

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Yes

No

Do you know of any other reason why you should not take part in physical activity?

Yes

No

I confirm that I have answered this PAR-Q honestly and understand that if I answered YES to any question, I should seek medical advice before participating in physical activity. If I answered NO to all questions, I may safely begin exercising and agree that I am participating voluntarily at my own risk. I understand that this PAR-Q becomes invalid if my health changes.

Knowledge of Hula Hooping

Complete beginner

Beginner - I’ve tried it a few times

Improver - I can hoop but still learning

Intermediate - comfortable with basic moves

Advanced - confident with a variety of moves

How long have you been hula hooping for?

Over 3 Months

1 Year

More Than 1 Year

Can you hula hoop in both directions?

Yes

No

Are you a certified fitness instructor? For example: Level 3 Personal Trainer, Exercise to Music, Group Fitness, or Hooping Instructor Qualifications.

Yes - please specify in other below your qualifications.

No

Other

Additional Qualifications

Any current injuries for us to be aware of?

Emergency Contact Name & Number

Thank you for your response - additional comments are welcomed!