WCBLWHITE COLLER BOXING LEAGUE

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)*

Rows	Yes	No
Do you have a bone or joint problem such as arthritis?
To your knowledge, do you have high blood pressure?
To your knowledge, do you have low blood pressure?
Do you have diabetes or any other metabolic disorder?
Has your doctor ever said that you have raised cholesterol?
Have you ever suffered a heart condition?
Have you ever felt pain in your chest when you do physical exercise?
Is your doctor currently prescribing you drugs or medication?
Have you ever suffered from shortness of breath at rest or with mild
Is there any history of Coronary Heart Disease within your family?
Do you ever feel faint, dizzy or lost consciousness?
Are you or might you be pregnant?
Do you suffer from epilepsy?
Do you have any blood-borne diseases (e.g., hepatitis, HIV)?
Do you have asthma?

If you answered 'YES' to any of the above, please give details:
ASSUMPTION OF RISK
I confirm that I have read and understood the above information and voluntarily participate in physical activity and boxing events acknowledging potential risks.
Client Name:*
Signature: (*As sho*
Date:

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Date
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WHITE COLLER BOXING LEAGUE