PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)
Print off this form and fill it in
For most people physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.
Common sense is your best guide in answering these few questions. Please read them carefully and check the yes or no opposite the question if it applies to you
|
Yes |
No |
1) Has a physician ever said you have a heart condition and you should only do physical activity recommended by a physician? |
|
Yes |
No |
2) When you do physical activity, do you feel pain in your chest? |
|
Yes |
No |
3) When you were not doing physical activity, have you had chest pain in the past month? |
|
Yes |
No |
4) Do you ever lose consciousness or do you lose your balance because of dizziness? |
|
Yes |
No |
5) Do you have a joint or bone problem that may be made worse by a change in your physical activity? |
|
Yes |
No |
6) Is a physician currently prescribing medications for your blood pressure or heart condition? |
|
Yes |
No |
7) Are you pregnant? |
|
Yes |
No |
8) Do you have insulin dependent diabetes? |
|
Yes |
No |
9) Do you have any breathing difficulties or suffer from asthma? |
|
Yes |
No |
10) Do you suffer from Epilepsy |
|
Yes |
No |
11) Have you had a major operation. If so, specify_________________________________________________________________ |
|
Yes |
No |
12) Do you suffer from any S.T.Ds |
|
Yes |
No |
13) Do you know of any other reason you should not exercise or increase your physical activity |
If you answered YES to any of the above questions, talk with your doctor by BEFORE you become more physically active. Tell your doctor your intent to exercise and to which questions you answer YES.
If you honestly answered NO to all questions you can be reasonably positive that you can safely increase your level of physical activity gradually.
If your health changes so you then answer YES to any of the above questions, seek guidance from a physician and immediately inform the Instructor.
By signing you certify that you have read, understood and completed this questionnaire honestly.
Participant signature _________________________________________________________ Date ______/______/______
Please complete and return
this form with your application form and payment to...
Stephen Foy
TIGA Martial Arts Academy
Unit 246 Hill House
210 Upper Richmond Road
London SW15 6NP