Physical Activity Readiness Questionnaire (PAR-Q)

Has your doctor ever said you have a heart condition?

YesNo

Do you have any pains in your chest when performing physical activity?

YesNo

Have you had chest pains not doing physical activity?

YesNo

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

YesNo

Do you have a history of coronary disease in your immediate family?

YesNo

Do you suffer from high or low blood pressure?

YesNo

Do you suffer from high cholesterol?

YesNo

Are you pregnant now or given birth in the last 6 months?

YesNo

Have you had any surgery recently?

YesNo

If your answer is "NO" to all of the questions above, then you are safe to participate in physical activity.

If you answer "YES" to one or more questions, then you need to consult your doctor to clarify if you're capable of doing physical activity in your current state.

Name

First NameLast Name

Gender

MaleFemaleOther

Age

Date of Birth

Date

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation

Emergency Contact Person

First NameLast Name

Emergency Contact Person No.

Area CodePhone Number

What are your fitness goals?

I give permission for photos and videos to be taken of me during classes and socials and for them to be used on GRIT social media with my approval

YesNo

INFORMED CONSENT1. A description of the exercise/ physical activities you will perform willbe given to you. The exercise intensity of each will be prescribed at anappropriate level relevant to your ability. The exercise session may bestopped if any signs of fatigue or discomfort are seen, you may also choose tostop if you feel you need to. 2. Risks and anxieties – the reaction of the body to exercise cannot always be predicted with accuracy. There is therefore a risk of certain abnormal changes occurring during exercise which may include abnormalities of blood pressure, fainting and in rare instances, heart attacks. In order to minimise these risks, it’simportant that you inform the personal trainer of any relevant informationrelating to your health, fitness and wellbeing.3. It is your responsibility to make your Gym Instructor / Personal Trainer aware of anything they should know regarding your current health status. This could includeinjuries (past or present), feeling unwell during or after a session. 4. There are numerous potential benefits that are derived from exercise, they may include: a reduction in body fat, improvement in blood pressure, increased physiological and psychology function. 5. All exercises/sessions are done with your permission - they are voluntary.You can opt out or stop the session at any stage.

I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities that may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.

YesNo

Physical Activity Readiness Questionnaire (PAR-Q)

Personal Information