WALK2HOME Par-Q

Physical Activity Readiness Questionnaire (Par-Q) and you
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Please read the questions carefully and answer each one honestly: check YES or NO.
PAR -Q

Regular physical activity is important to your health, and increasingly more people are starting to become more active every day. Becoming more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly:

	Yes	No
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose balance because of dizziness or do you ever lose consciousness?
5. Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
6. Are you currently pregnant?
7. Do you have diabetes or thyroid condition?
8. Do you know of any other reason why you should not engage in physical activity?
9. Do you plan to become pregnant in the next 3 months?
10. Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?

If you answered Yes to any questions 1-8 above, A MEDICAL CLEARANCE FORM IS REQIRED of all participants prior to beginning training. If YES to any, physical and aerobic fitness activities CANNOT be administered. NOTE: Coaching staff reserve the right to require medical clearance from any client they feel may be at risk. Discuss with your personal doctor any connditions that may affect your exercise program. All precautions must be documented on the medical clearance form by your personal doctor.
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If you answered Yes to any questions 9 or 10, WALK2HOME requests written permission from your physician before you may participate in physical and aerobic fitness activities. If you choose not to get written permission, you must acknowledge by signing below that Gold's Gym has asked you to visit your physician to obtain medical release before beginning an exercise program. You have elected not to do so and assume the risk for any injuries arising from undertaking any and all exercise due to a known or unknown medical condition
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If you answered NO to all questions above, you have provided to WALK2HOME a general indication that you may participate in physical and aerobic fitness activities and/or fitness evaluation testing. The fact that you answered NO to the above questions is no guarantee that you will have a normal response to exercise or that a fitness regimen will not cause you medical problems.

Please note: 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.
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Physical Activity Readiness Questionnaire (Par-Q) and you

PAR -Q