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C Shaw Wellbeing by the seashore

ADULT PAR-Q Form

CHILD PAR-Q form

Please fill out the following form
in order for your child to participate in our activity.

First Name

Child Date of Birth

Parent Email

Has your child been hospitalized in the last 12 months?

No

Yes

Is your child currently taking any medication? *

No

Yes

Last Name

Parent Name

Parent contact number

Are they suffering from a medical condition, illness, or injury?

No

Yes

Is your child cleared by a medical professional to take part in exercise? *

No

Yes

If you answered yes to any question, please elaborate

Do you give pemission fo C Shaw Wellbeing to take photos of your child for marketing purposes? *

No

Yes

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Photography/video consent & release form

First Name

Last Name

Email

Date of Birth

Initials

I hereby give my consent to use my photographs according to the terms & conditions

Thanks for submitting!

Create your own Ripple effect of continuous results

gemma@cshawwellbeing.com

© C Shaw Wellbeing

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