• Physical Activity Readiness Questionnaire (PAR-Q+)

    Complete this form to determine if you need further medical advice before becoming physically active.
  • Date*
     - -
  • 1) Has your doctor ever said that you have a heart condition OR high blood pressure?*
  • 2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?*
  • 3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?*
  • 4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?*
  • 5) Are you currently taking prescribed medications for a chronic medical condition?*
  • 6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?*
  • 7) Has your doctor ever said that you should only do medically supervised physical activity?*

  • If you answered YES to one or more of the questions above, please seek further advice from your doctor or a medical professional. Please click the Exit Button below to exit the PARQ + Release Waiver Form.

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  • If you answered NO to all of the questions above, you are cleared for physical activity.
    Please sign the PARTICIPANT SIGNATURE.

  • RELEASE WAIVER FORM

  • Date
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 1. Recognize and understand that martial arts training is an activity that involves physical contact and that my participation might result in serious injury, including permanent disability or even death, and severe social and economic loss.

    2. Recognize and understand that such risk may be due to not only my own actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises, or of any of the equipment used.

    3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.

    4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate.

    5. Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death.

    6. Enter martial arts training entirely of my own free will and understand the importance of following the rules of training.

    7. I certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during intense training practice and/or competition.

    8. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury.

    9. Release, waive, discharge and covenant not to sue, Terrell Hill, Kelly Miller, Ceallach Martial Arts, Panorama Tower, Florida East Coast Realty LLC., its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the lessor or otherwise.

    I agree that there have been no warranties, expressed or implied, which have been made to me beyond the information written on this form. I, the undersigned, acknowledge that I have read this Warning Assumption of Risk, Hold Harmless, Indemnification and Release of Liability agreement and I understand its contents. I understand that my signature below expressly waives any rights I may have to sue Terrell Hill, Kelly Miller, Ceallach Martial Arts, Panorama Tower, Florida East Coast Realty LLC., for injuries and/or damages

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