EXERCISE/ACTIVITY PAR-Q

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Physical Activity Readiness Questionnaire to access your readiness to take part in physical activity.

Please read the questions carefully and answer each one honestly, giving details where answering yes.

All information obtained is confidential and follows GDPR guidelines.

Email *

Name *

Date of Birth *

YYYY

Contact Number *

Emergency Contact Person *

Emergency Contact Persons Number *

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

Yes

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

Yes

In the past month have you experienced any unexplained chest pain? *

Yes

Do you lose your balance due to dizziness or do you ever lose unconsciousness *

Yes

Do you have a bone or joint problem that could be made worse by a change in physical activity? *

Yes

Do you suffer from asthma? *

Yes

Are you currently taking any medication? *

Yes

If 'Yes' to medication, please give some details

Are you pregnant or have had a baby in the past 6 months? *

Yes

Not Applicable

Do you know of any other reason why you should not do physical activity or have any condition that may be made worse by physical activity? *

Yes

Additional Information

If you have answered 'Yes' to any of the questions above, please seek advice from your GP/Doctor unless prior advice has been sought. Should your health status change, please inform us as soon as possible. *

I hereby certify that I know of no medical problems that could increase my risk of illness and injury as a result of participation. I have read, understood and completed this questionnaire to my full knowledge and satisfaction.

Required

Assumption of Risk and Release of Liability: Participating in any physical fitness activity, I recognise and understand that the services offered is not without varying degrees of risk which may include, but are not limited to financial loss, injury or even death, due to negligence, improper use or failure of equipment, medical condition, whether known or unknown to me. I hereby certify that I know of no medical problems that could increase my risk of illness and injury as a result of participation. *

I hereby willingly assume full responsibility for any and all risks and waive any responsibility and liability connected to my participation

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