Physical Activity Readiness Questionnaire (PAR-Q)
Please read each question carefully and answer each one honestly.  
This questionnaire is to be used by individuals between the ages of 15 and 69.
If you are over the age of 69 please check with your doctor before participating in physical activity.

Please complete the PAR-Q form.  

If you have any questions please send an email to jacob@food4thoughts.com
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Email *
Full Name *
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
Required
In the past month, have you had chest pain when you are not doing physical activity? *
Required
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Required
Do you have a bone or joint problem that could be made worse by a change in your physical activity?  (Examples: back, hip or knee) *
Required
Is your doctor currently prescribing drugs for your blood pressure or heart condition? *
Required
Do you know of ANY OTHER REASON why you should NOT do physical activity? *
Required
If you answered yes to any of the above questions please describe in more detail as to why you answered "yes". *
I am hereby affirm that I am voluntarily enrolling on a session of of exercise in the form of Resistance/HIIT training/walking/hiking. I am voluntarily participating in the Activity entirely at my own risk.  I acknowledge that I have carefully read this form and fully understand that it is a release of liability.
In full consideration of the risk of injury while participating in the Activity, and for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily participate in this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any kind of risks related to traveling to and from as well as participating the Activity, which may include, but are not limited to, physical or phycological injury, pain, suffering, illness disfigurement, temporary or permanent disability, economic or emotional loss, and death.
I expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I may otherwise have to bring a legal action for personal injury or property damage.
Full Name *
"I have read, understood and completed the questionnaire.  By selecting 'Agree' it will act as my signature on this qustionnaire." *
Date *
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A copy of your responses will be emailed to the address you provided.
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