PAR-Q (Page 1 of 8)

Overview

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the questions in the box below. Common sense is your best guide when you answer these questions.

Please read the questions carefully and answer each one honestly.

PAR-Q (Page 2 of 8)

Personal Information

First Name

Last Name

Age

Mobile

PAR-Q (Page 3 of 8)

Emergency Contact

EC Name

EC Mobile

PAR-Q (Page 4 of 8)

Questions 1 thru 6 of 7

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

Yes No

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

Yes No

In the past month, have you had chest pain when you were not doing physical activity?

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes No

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

Yes No

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Yes No

PAR-Q (Page 5 of 8)

Question 7 of 7

Do you know of any other reason why you should not do physical activity?

Yes No

Explain Other Reasons

PAR-Q (Page 7 of 8)

Summary

If you answered YES to any questions

Talk to your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

If you answered NO to all questions

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can start becoming much more physically active. Begin slowly and build up gradually. This is the safest and easiest way to go.

In all cases

Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

I Agree

Acceptance

I acknowledge that I have completed the Physical Activity Readiness Questionnaire (PAR‑Q) honestly and to the best of my knowledge.

A copy of the completed PAR‑Q form will be emailed to you, with a copy also sent to your trainer or coach at GBSC. All information is kept private and is not shared with any other individuals or organizations, except if required to resolve a dispute involving this form or your participation.

I understand that if my health status changes, or if any of my answers to the PAR‑Q questions change in the future, I will immediately inform my trainer or coach.

I confirm that I have read and understand this acceptance statement.

Name (If under the age of 18, must be a parent/guardian)

I confirm that I have read and accept the statements above.

Physical Activity Readiness Questionnaire (PAR-Q)

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PAR-Q (Page 7 of 8)

Acceptance