PAR-Q FormΔPAR-Q (PHYSICAL ACTIVITY READINESS QUESTIONNAIRE)1. Has your doctor ever said that you have a bone/joint problem, such as arthritis, that might be, aggravated by exercise? Yes No2. Do you have high blood pressure? Yes No3. Do you have low blood pressure? Yes No4. Do you have Diabetes or any other metabolic disease? Yes No5. Has your doctor ever said that you have raised cholesterol? Yes No6. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor? Yes No7. Have you ever felt pain in your chest when you do physical exercise? Yes No8. Have you ever suffered from shortness of breath at rest or with mild exertion? Yes No9. Is there any history of Colonary Heart Disease in your family? Yes No10. Do you frequently feel faint, or have spells of dizziness or lost consciousness? Yes No11. Are you, or is there any possibility that you might be, pregnant? Yes NoIf you answered 'Yes' to one or more questions, please consult your doctor IF you have not already done so. Show your doctor this form. Ask your doctor's advice on your suitability for physical activity.Please give details you feel relevantAssumption of Risk I hereby state that I have read and understood the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every class and I accept that neither the instructor nor the hosting facility is liable for any injury, or damage to person or property resulting from taking the class. Those under 18 years of age must have a parent or guardian present at registration.Client's NameDate / TimeEmailSubmit
