Taekwondo4Fitness T-PAR-Q

Taekwondo Physical Activity Readiness Questionnaire

T-PAR-Q
Please fill in this questionnaire and give it to your instructor before training or on renewal of your membership.
PAR-Q applies to: *

Adult only Child/Children only Adult & Child/Children
Please read the following essential health questions and tick them appropriately.
*

Has your doctor ever indicated that you have a heart condition or that you have high blood pressure? Have you ever had chest pains brought on by physical exertion? Do you lose consciousness or lose your balance as a result of dizziness? Are you currently on any form of medication (e.g. tablets, inhaler)? Do you suffer from diabetes, epilepsy or asthma? If so, please give details to your instructor. Do you have bone, joint, back or muscular problems that might be aggravated by exercise? Are you pregnant, or have you given birth in the last three months? Is there any reason not mentioned above why exercise/ Taekwondo activity may not be suitable for you? None
Additional comments (optional):
If you have answered yes to any question above, before a physical activity program or Taekwondo training can begin, you must seek advice and get a letter from your doctor stating that you can participate in physical activity. This form must be given to the instructor/coach before any training can begin.
You take part in all physical activity and Taekwondo programs at your own risk.
If your circumstances change and affect your health or well-being when carrying out any physical activity, your responsibility is to inform your instructor/coach.
Adult / Guardian for under 18yrs
Name *

First Name Last Name
Birth Date *

Month Day Year
Name of child 1 (optional)

First Name Last Name
Birth Date (optional)

Month Day Year
Name of child 2 (optional)

First Name Last Name
Birth Date (optional)

Month Day Year
Country of residence *
Please sign: *

Clear
Date: *

Day Month Year
Date
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Taekwondo Physical Activity Readiness Questionnaire

Adult / Guardian for under 18yrs