TANAKA TRAINING: PAR-Q & INFORMED CONCENT

This PAR-Q Questionnaire is the first step in getting to know you better and tailoring a wellness journey that’s all about you. Think of it as the foundation for building strength, confidence, and a happier, healthier you. The first few questions will help me understand your current health and fitness background—it’s the “serious stuff” to keep you safe and thriving.

But here’s the fun part! At the end, you’ll get to share your “why”—what’s inspiring you to make this change and how you envision feeling stronger and more vibrant. This is where I get to hear your story, cheer you on, and start crafting a plan that fits your life and goals. I promise to keep this process simple and empowering. Let’s get started and build something amazing together!

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 question you are first advised to consult your doctor prior to participating in any exercise program.

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

YesNo

Do you feel pain in your chest when you do physical activity?*

YesNo

In the past month, have you had chest pain when you were not doing physical activity?*

YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness?*

YesNo

Do you have a bone or joint problem that could be made worse by a change in your physical activity?*

YesNo

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

YesNo

Do you know of any other reason why you should not do physical activity?*

YesNo

Date of Birth*

Date

Name*

First NameLast Name

Signature*

I, the undersigned do hereby agree & acknowledge:

My consent to perform an exercise program designed by a trained fitness consultant; where it will not be supervised closely by an appropriately qualified person*

AgreeDisagree

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

AgreeDisagree

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.*

AgreeDisagree

My obligation to immediately inform my online coach of any abnormal symptoms that I may suffer while exercising.*

AgreeDisagree

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

AgreeDisagree

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

AgreeDisagree

That I hereby release DENIZ KILIC and STRENGTH AND SOUL WELLNESS from any liability with respect to any damage or injury that I may endure while exercising*

AgreeDisagree

Date of Birth*

Date

Name*

First NameLast Name

Signature*

1) Welcome to Your Strength and Soul Journey!

2) Informed Consent Document

3) Now for the Fun Part!