PAR-Q

Skyway Performance

Physical Activity Readiness - Questionnaire (PAR-Q)
Participant's Name*

First NameLast Name
Please answer the following questions.

If you are a minor (under the age of 18), please complete this form with the help of your parent/guardian. Note: If you answer "YES" to any question, you may need to consult a physician before starting a physical activity program.

YES/NO*

	YES	NO
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/ or that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you answered "YES" to any of the above, please elaborate:
Parent/Guardian Name (if participant is under the age of 18)

First NameLast Name
I confirm that I have answered all questions in the PAR-Q truthfully and to the best of my knowledge. I understand that this form is used to assess my readiness for physical activity and does not replace professional medical advice. I acknowledge that I am responsible for consulting a healthcare provider if I have any concerns about my health and fitness before participating in training. I understand this serves as my legal acknowledgment in place of a physical signature.

I confirm
Date*

MonthDayYear
You can print the form with "Print Form" before the submission in order to get a hard copy for your records.
Should be Empty:

Skyway Performance