HEALTH FORM (PAR-Q)

The following questions in this Physical Activity Readiness Questionnaire helps to assess any potential risks or health issues before beginning an exercise program.

First name*

Last name*

Email*

Phone (preferably mobile)*

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

Do you ever feel pain in your chest when you do physical activity? *

Yes

Have you ever had chest pain when you were not doing physical activity? *

Yes

Do you ever feel faint or have spells of dizziness?*

Yes

Do you have a joint problem that could be made worse by exercise? *

Yes

Have you ever been told that you have high blood pressure? *

Yes

Are you currently taking any medication of which the instructors should be made aware? *

Yes

If yes, please explain below:

Are you pregnant or have you had a baby in the last six months? *

Yes

Is there any other reason why you should not participate in physical activity? *

Yes

Declaration and Signature

I hereby declare that the information provided in this questionnaire is true, accurate, and complete to the best of my knowledge. I understand that it is my responsibility to inform my trainer or coach of any changes to my health, fitness, or physical condition. I acknowledge that participating in physical activity involves a risk of injury, and by completing this form, I consent to engaging in physical activity with the understanding of these risks. I also agree to follow any guidelines or advice provided by my coach or trainer.

I consent to the use of my data for health and safety purposes and to contact me regarding training services, as per the privacy policy.

Signature

Date