PNC PT: PAR-Q (Physical Activity Readiness Questionnaire)

Moderate or vigorous exercise should not be a hazard for most people providing it is undertaken as part of a regular program starting from low intensity and progressing gradually. However, some people will need medical evaluation and advice before starting a program, some may need to exercise under medical supervision and some people may only be able to undertake restricted physical activity under medical supervision.

If you answer NO to all the questions, it is reasonable for you to assume that you are in a suitable physical condition to start a regular graduated exercise program.

If you answer YES to one or more questions, you are first advised to consult your doctor prior to participating in any exercise program.

Has your medical practitioner ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?

Do you ever feel faint, dizzy or lose your balance during physical activity or do you ever lose consciousness?

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

Do you have any diagnosed muscle, tendon, bone or joint problem that could be made worse by participating in exercise?

Is your doctor currently prescribing medications for your blood pressure, heart condition or for any other health concerns?

Do you know of any other reason/conditions why you should not do physical activity or special considerations required for you to exercise?

Date

Name

First NameLast Name

Signature

I, the undersigned do hereby agree & acknowledge:

My consent to perform an exercise program / group fitness session designed by trained fitness professionals.

My understanding that exercises will consist of one or more of the following components: cardiovascular, resistance training (strength, endurance, hypertrophy, power, stability) and flexibility.

I fully understand that there are potential risks, i.e. episodes of transient light-headedness or possibly loss of consciousness, and I willfully assume these risks.

My obligation to immediately inform my trainer of any abnormal symptoms that I may suffer whilst exercising. Also if I have sustained any injuries elsewhere before the start of the session.

I acknowledge that any nutritional or supplementation advice given is not a medical prescription and should be consulted with my healthcare professional.

That I have read, understood, and completed the medical screening questionnaire (PAR-Q) above and obtained medical clearance if necessary.

That I hereby release any trainer employed by PNC PT from any liability with respect to any damage or injury that I may suffer whilst exercising

I have read and understood all details of the Informed Consent Document above and fully understand its contents. I voluntarily agree to the terms and conditions.

Date

Name

First NameLast Name

Signature

1) PAR-Q (Physical Activity Readiness Questionnaire)

2) Informed Consent Document