Signup

Physical Activity Readiness Questionnaire (PAR-Q)

Name: {name}

Date: {sign_date}

Date of Birth: {dob}

For participants under 18:

Parent/Guardian Name: {contact_name}

Please read each question carefully and answer honestly by checking Yes or No:

1. Has a doctor ever said that you/your child have a heart condition AND that you should only do physical activity recommended by a doctor? Yes No
2. Do you/your child feel pain in your chest when doing physical activity? Yes No
3. In the past month, have you/your child had chest pain when not doing physical activity? Yes No
4. Do you/your child lose balance because of dizziness or ever lose consciousness? Yes No
5. Do you/your child have a bone or joint problem that could be made worse by physical activity? Yes No
6. Are you/your child currently taking prescribed medication for blood pressure or a heart condition? Yes No
7. Do you know of any other reason why you/your child should not do physical activity? Yes No

Additional Medical Information:

If you answered YES to one or more questions: Talk to your doctor BEFORE becoming more physically active. Show them this form and discuss which questions you answered YES to.

If you answered NO to all questions: You can be reasonably sure that you can start becoming more physically active. Begin slowly and build up gradually.

Declaration: I have read, understood and completed this questionnaire honestly.

For participants 18 and over: Signature: Date: {sign_date}

For participants under 18: Parent/Guardian Signature: Date: {sign_date}