PAR Q - Sterne Performance

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Emergency Contact Name*

First NameLast Name

Relationship

eg. spouse, partner, significant other..

Phone Number*

Area CodePhone Number

Email*

example@example.com

There are many health benefits associated with regular exercise. The completion of this PAR-Q is the first step to take if you are planning to increase the amount of physical activity in your life.

PAR-Q's are designed to identify the small number of individuals for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the best guide in answering these questions. If you remian unsure as to your answers, seek professional & medical advice.

Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?*

YesNo

Do you have high blood pressure?*

YesNo

Do you have low blood pressure?*

YesNo

Do you have diabetes mellitus or any other metabolic disease?*

YesNo

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

YesNo

Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)?*

YesNo

Have you ever felt pain in your chest when you do physical activity?*

YesNo

Is your doctor currently prescribing you drugs or medication?*

YesNo

Have you ever suffered from unusual shortness of breath at rest or with mild exertion?*

YesNo

Is there any history of coronary heart disease in your family?*

YesNo

Do you often feel faint, have spells of sever dizziness or have lost consciousness?*

YesNo

Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women?*

YesNo

Do you currently smoke?*

YesNo

Do you NOT currently exercise on a regular basis (at least 3 times a week) and/or work in a job that is physically demanding?*

YesNo

Are you, or is there any possibility that you might be pregnant?*

YesNo

Do you know of any reason why you should not participate in a program of physical activity?*

YesNo

Do you have any injuries that would stop you from participating in exercise or a physical activity programme? **

YesNo

If you answered 'Yes' to one or more questions:

If you have not recently done so, consult with your doctor by telephone or in person before increasing your physical activity and/or taking a fitness appraisal. Tell your doctor what questions you answered 'Yes' to on the PAR-Q or present your PAR-Q copy. After medical evaluation, seek advice from your doctor as to your suitability for:

Unrestricted physical activity, starting off easily and progressing gradually; and
Restricted or supervised activity to meet your specific needs, at least on an initial basis.

It is your full resposibiity to take all nesseccary medical steps as stated above before signing this form.

If you answered 'No' to all questions:

If you answered your PAR-Q accurately, you have reasonable assurance of your present suitability to take part in physical activity.

Assumption of Risk:

I hereby state that I have read, understood, and answered honestly the questions of the PAR-Q. I also state that by participating in any training, coaching, or physical activity provided by Sterne Performance, I acknowledge and accept that physical exercise carries inherent risks, including possible injury, illness, or even death. Sterne Performance is not liable for any injury, illness, or condition — whether past, present, or future — that may occur as a result of participation in Sterne Performance's services, including but not limited to in-person training, online coaching, all programming, or any materials provided.

Furthermore, I hereby confirm that I am voluntarily engaging in exercise with Sterne Performance and its coaches, staff, and affiliates, and do so at my own risk. It is my responsibility to communicate any health concerns prior to my participation in any services provided.

Declaration for Minors:

If you are under the age of 18, this PAR-Q must be signed by a legal guardian on behalf of the participating minor.

Terms & Conditions:

I hereby state I have read and agree to the terms & conditions stipulated by Sterne Performance (link:https://sterneperformance.com/terms-and-conditions).

Name*

First NameLast Name

Legal Guardian Name (if under 18)

First NameLast Name

Date*

Date

Signature ( OR Legal guardian signature - if under 18) *

ONLY Required if said 'YES' to any answers above: 'I declare that I have taken medical advice from a qualified professional and my doctor has agreed that I should exercise'.

Signature

Date

ADVANCED PAR-Q

EMERGENCY CONTACT INFORMATION