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Physical Activity Readiness Questionnaire (PAR Q)

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If this form is being completed on behalf of a child under the age of 18, it must be signed by a parent or guardian. All details completed must be for the child except the emergency contact details and email consent. The emergency contact details given must be semeone that we can contact at any time during the time your child is with us.

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If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change you physical activity patterns.

If you are over 69 years of age and are not used to being very active, check with your doctor.

Please read each question carefully and answer honestly by indicating YES or NO.

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

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

In the past month, have you had a chest pain when you were not doing physical activity?

Do you lose balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity?

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Do you know of any other reason why you should not take part in physical activity?

If YES, please comment:

Any other medical conditions that we should be aware of:

Physical Activity Readiness Questionnaire (PAR Q)

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