CORNER - PARQ

Physical Activity Readiness Questionnaire (PARQ) and disclaimer
Introduction

The PARQ and disclaimer governs our classes and we require your signature before taking part in any classes. All exercise involves a risk of personal injury and you must agree to take responsibility for your health and well-being in relation to our sessions provided.
Full Names

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?

Health and medical conditions

You acknowledge that your doctor has approved your participation in our classes if you ticked yes to any of the above. If you feel pain or discomfort during a class or you feel the exercise is unsafe or uncomfortable you must let the instructor know immediately.
Fitness Participation Agreement

I have voluntarily chosen to participate in any of Corner's classes or 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 CORNER, staff and all relevant employees 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.
Signature of Participant:
Should be Empty:

Physical Activity Readiness Questionnaire (PARQ) and disclaimer