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.
Please read the following essential health questions and tick 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 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
- If you have answered yes to any question above, before a physical activity programme 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 letter must be given to the instructor/coach before any training can begin.
You take part in all physical activity and Taekwondo programmes at your own risk.
If your circumstances change and affect your health or well being when carrying out any physical activity, then it is your reasonability to inform your instructor/coach.
Name of child 1

First Name Last Name
Name of child 2

First Name Last Name
Adult / Parent or Guardian for under 18yrs
Name *

First Name Last Name
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.
Should be Empty:

Taekwondo Physical Activity Readiness Questionnaire

Adult / Parent or Guardian for under 18yrs