體能活動適應能力問卷 (PAR-Q)

Name 姓名*

First NameLast Name

What should I call you? 你想我們怎樣稱呼你？

Email 電郵地址*

example@example.com

Phone Number 電話號碼*

Please enter a valid phone number.

Emergency contact number 緊急聯絡人電話*

Please enter a valid phone number.

Name of Emergency contact person 緊急聯絡人姓名*

First NameLast Name

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? 醫生曾否說過你的心臟有問題，以及只可進行醫生建議的體能活動？*

Yes 是No 否

2. Do you feel pain in your chest when you do physical activity? 你進行體能活動時會否感到胸口痛？*

Yes 是No 否

3. In the past month, have you had chest pain when you were not doing physical activity? 過去一個月內，你曾否在沒有進行體能活動時也感到胸口痛？*

Yes 是No 否

4. Do you lose your balance because of dizziness or do you ever lose consciousness? 你曾否因感到暈眩而失去平衡，或曾否失去知覺？*

Yes 是No 否

5. 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? 你的骨骼或關節(例如脊骨、膝蓋或髖關節)是否有毛病，且會因改變體能活動而惡化？*

Yes 是No 否

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? 醫生現時是否有開血壓或心臟藥物（例如 water pills）給你服用？*

Yes 是No 否

7. Do you know of any other reason why you should not do physical activity是否有其他理由令你不應進行體能活動？*

Yes 是No 否

Note:

The information provided by you is used for PARQ assessment, communication and marketing purposes only. If you need to update the information, please contact us via whatsapp or email.
If you answered "Yes" to one or more questions, it represents that your body condition may not be suitable to join the concerned activity. For the sake of safety, please consult your doctor for further advice.
If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Source: The Canadian Society for Exercise Physiology

備註：

你提供的資料，只作評估體適能、聯絡及宣傳事宜之用。如需更改，請或whatsapps或電郵通知本公司。
如果在上述問卷中有一個或以上「是」的答案，即表示你的身體狀況可能不適合參與有關活動。故為安全起見，請你先行諮詢醫生的意見。
如因健康狀況轉變，致使你隨後須回答「是」的話，便應告知醫生或健身教練，看看應否更改你的體能活動計劃。

問卷來源：The Canadian Society for Exercise Physiology

LIABILITY WAIVER:

I fully understand and am aware that exercising is a potentially hazardous activity and that fitness activities involve the risk of injury or even death. I hereby confirm that I voluntarily participate in the activities and programs offered by Blute Fitness Limited and use the equipment and machinery with knowledge of dangers and risks involved. I hereby expressly assume and accept all risks, dangers, potential injury or death involved. I do hereby expressly waive, release, and discharge all claims, liabilities, actions or otherwise which I have or may in the future have against Blute Fitness Limited, its directors, officers, employees and shareholders, on account of all injuries or damages arising out of or attributable to my participation in the above mentioned activities.

免責聲明：

我清楚明白及知道運動是有一定的潛在風險，且所有種類的運動也有可能導致受傷或死亡。我現確認本人乃自願參與 Blute Fitness Limited 所提供的運動和課堂及使用其所提供的設備和器械。我在此明確表示我已預算及接受其所帶來的風險及傷亡的可能。我特此豁免、放棄和解除我所擁有或可能在未來擁有對 Blute Fitness Limited，其董事、高級職員、員工和股東的所有索賠、責任、行動或其他因為本人參與上述活動而引起的傷害或損害。

Signature*