Minor Physical Activity Readiness Questionnaire (PAR-Q)

Minor Physical Activity Readiness Questionnaire (PAR-Q)
In signing this form, I hereby agree to and accept the following:
- I am authorised to assume responsibility for the minor named herein either by means of legal guardianship; or have attained permission from their legal guardian.
- I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which the minor may incur as a result of participating in this class.
- I understand that a minor is not permitted to use weights during the “Strength” section of the fitness class. It is my responsibility, not the instructor in charge, to monitor and ensure this.
- I assume full responsibility for the minor’s behaviour before, during and after the class. If at any point their actions or behaviour becomes disruptive, or in any way compromises the safety of other clients, I am expected to take appropriate action to stop this.
Minor's Name

First NameLast Name
Date of Birth

DayMonthYear
Age
Responsible Adult's Name

First NameLast Name
Today's Date

DayMonthYear
Date
Signature
Should be Empty: