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PAR-Q and Informed Consent

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 your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide during these questions. Please read carefully and answer each one honestly.

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Please select either YES or NO for each question.

Health Questions
1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No
2. Do you feel pain in your chest when you do physical activity?
Yes
No
3. In the past month, have you had chest pain when you were not doing physical activity?
Yes
No
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No
5. Do you have a bone or joint problem (e.g. back, knee or hip pain) that could be made worse by a change in your physical activity?
Yes
No
6. Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
7. Do you know of any other reason why you should not do physical activity?
Yes
No
Medical Advice

It is reasonably safe for you to participate in physical activity, gradually building up from your current level of fitness.

Purpose of the Programme
You are invited to participate in a programme of physical exercise, which may include Pilates, strength training, flexibility, cardiovascular conditioning, and functional movement activities. The purpose of this program is to improve your overall fitness,
Responsibilities of the Participant
Waiver and Release of Liability
Consent and Acknowledgment
Participant Details
Date
Day
Month
Year
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