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PAR-Q Form

Physical Activity Readiness Questionnaire (PAR-Q)
Physical Activity Readiness Form
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For most people, physical activity should not pose any problems or hazards to health. This questionnaire has been designed to identify anyone for whom physical activity may not be appropriate, or for those who should have medical advice concerning the type of activity most suited for them.

Your Personal Details

Name
Address

Emergency Contact Details

Emergency Contact Name

Medical Questions

Have you had any major surgery, illness or injury in the last 5 years?
Are you currently receiving treatment for a diagnosed medical condition?
Are you currently taking any medications?
Do you suffer from any chest or heart trouble that can be aggravated by exercise?
Are you diabetic or suffer from high blood pressure?
Do you have asthma or experience any exercise induced breathing problems?
Do you have any bone or joint problems that may be aggravated by exercise?
Are you pregnant or have you given birth in the last 6 months?
Should the instructors be aware of any other health concerns that may impact your ability to exercise?

Waiver

I confirm I have answered all the questions in this form honestly and I am aware that if I answered ‘Yes’ to any of them, I should consult with my doctor before starting an exercise programme. By signing the Physical Activity Readiness Questionnaire (PARQ), I release and discharge the Ardrossan Community Sports Hub & Fitness Centre and their staff, for any claim, injuries, losses or liabilities suffered or incurred as a result of my participation in any fitness classes or use of the gym facilities.
I can confirm that i have answered all questions honestly and that the information given is correct
By typing your full name in this box you are confirming the above statement
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