Dear Parents,

We need you to complete this Physical Activity Readiness Questionnaire in order for your children to participate in class,
Thank you

Nursery/School Name :

Location :

Your Child’s name :

Please answer and choose as appropriate:
Is your child known to have any heart problems? YESNO
Is your child diabetic? YESNO If yes please tell us which type? TYPE 1TYPE 2
Has your child got asthma? YESNO
Has your child got any disabilities? YESNO
If yes please provide more information?

Is there any reason why your child cannot participate in any of our programmes at Stretch-n-Grow?

Parent/Guardian Signature :

Confirm the details are correct :

Address :

Telephone :

Email :