FoxFit PARQ

FoxFit

Physical Activity Readiness PARQ Form
Full Name*

First NameLast Name
Email
example@example.com
Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date of birth month day year
If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change you physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

Please read each question carefully and answer honestly by indicating YES or NO.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?*

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

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

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

YesNo
Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?*

YesNo
Is your doctor currently prescribing medication for your blood pressure or heart condition?*

YesNo
Do you know of any other reason why you should not take part in physical activity?*

YesNo
If you answered YES to the above question please comment below.
Have you had COVID-19?

YesNo
If you answered YES to one or more questions:

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If you answered NO to one or more questions:

It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.

A fitness appraisal can help determine your ability levels.

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.
Signature

Clear
Date signed:
Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise.
Signature

Clear
Date signed:
NOTE: This PAR Q becomes invalid if your condition changes so that you would answer YES to any of the 7 questions.
Should be Empty: