Exercise Safety Questionnaire

17 Years & Under

Exercise Safety Questionnaire

  • Regular physical activity provides a wide range of immediate and long term health benefits. The benefits far outweigh the risks; however a very small number of people may be at risk when exercising. To help provide the highest level of safety, please complete the following form prior to your child taking part in any physical activity. This information is confidential and will be treated as per the amended Privacy Act 1988.

Emergency Contact Details - Parent or Guardian


Has your child been diagnosed with a medical condition?


Has your child experienced any abnormal episodes?


Does your child have any muscle/bone or joint problems?


Does your child have any neuromuscular difficulties such as brain or spinal injuries?


Does your child have any sensory issues such as vision/hearing/speech or balance issues?


Does your child have any allergies of any kind?


Does your child currently take any medication?


Is there any other medical reason/condition which might prevent your child from participating in an exercise program?