PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

  •  PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

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  • Emergency Contact Person and Cell

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  • Section One: Medical Review

  • Do you have any past injuries or chronic illnesses that limit you from performing physically challenging activities?*
  • Do you lose your balance because of dizziness or do you ever lose consciousness?*
  • Are you taking any prescribed medication at this time?*
  • Do you feel pain in your chest when you exert yourself?*
  • Are you currently under a doctor’s care?*

  • If you answered yes to any of these questions, please consult a physician before registering in this or any exercise program.

  • Section Two: Physical Readiness Review

  • Exercise habits and preferences (select one):

  • Exercise*
  • I like to workout:*
  • Discipline*
  • Help with fitness program*
  • Weights*
  • I perfer the following for my cardiovascular endurance training.*

  • My personal fitness goals (select all that apply):

  • I want to:*

  • Section Three: Self-assessment

  • Overall personal fitness rating: 
    On a scale of 1-10 where 10 is best and 1 is the least, what score would you give yourself regarding your overall level of physical conditioning?

    We will ask you this same question when the session is finished and hopefully you will see your progress.

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  • I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE POLICIES.

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