PAR-Q

Full Name

First NameLast Name

Contact email

example@example.com

Emergency name:

First NameLast Name

Emergency contact number:

Area CodePhone Number

Please read the following questions carefully and check (X) next to the appropriate answers. Answer all questions honestly and to the best of your ability.

YES/ NO

Rows	Yes	No
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

Fitness Participation Agreement

I have voluntarily chosen to participate in Chloe's exercise program. I have answered the questions above to the best of my ability and affirm that my physical condition is good and I have no known conditions that would prevent me from participation. I acknowledge that participation is at my own pace and comfort level and that I may discontinue my participation at any time. Furthermore, I agree to self-determine my exertion through good judgement and to discontinue any activity that exceeds my personal limitations. I understand that by signing this agreement that I hereby waive and release Chloe and Fit To Fly in any way from liabilities or demands as a result of injury, loss, adverse health conditions or death as a result of my participation. I affirm that I have read and understand ths document and I wish to participate in fitness activities.

Statements

Statement 1: By completing this Health Agreement (PAR-Q) I confirm that I have responded to the above statements accurately.

Statement 2: If I have highlighted any health concerns detailed above I understand that I am required to discuss my exercise programme within a gym environment with my Doctor or Health Professional and to take advice on activities which are safe to participate in.

Statement 3: In the event that I have been advised to seek medical clearance prior to undertaking exercise, I agree to contact my doctor and take responsibility for obtaining written permission prior to the commencement of my exercise programme in a gym environment.

Statement 4: Should any change in my Health or unusual symptoms occur at any point, I will cease participation and inform a Doctor of these symptoms.

Statement 5: I understand that I must notify you immediately of any changes in my health.

Statement 6: Assumption of Risk: I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.

Signature of Participant:

Physical Activity Readiness Questionnaire (PARQ) and disclaimer

Introduction

Health and medical conditions