Physical Activity Readiness Questionnaire (PAR-Q)

Physical Activity Readiness Questionnaire (PAR-Q)
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If you answered YES to the question above please provide below full information including any medical diagnosis and how the above affects your ability to move freely without pain and exercise.
YesNo
If you answered YES to the question above please specify and also explain how this medication affects your ability to exercise or achieve your fitness goals?
YesNo
If you answered YES to the question above please specify:
If you have answered YES to any of the questions above please check with a medical professional prior to participating in the class.
Personal Information
Name

First NameLast Name
Emergency Contact Person

First NameLast Name
Emergency Contact Person No.

Area CodePhone Number
Should be Empty:

Personal Information