Physical Activity Readiness Questionnaire

Name*

First Last

Please answer each of these questions. Do you have…

Shortness of breath during light exertion

Pain, pressure, heaviness, or tightness in the chest area

Unexplained pain in the abdomen, shoulders, or arms

Dizzy spells or episodes of fainting (unconsciousness)

Lower leg pain during walking that is relieved by rest

Palpitations or irregular heartbeats

Bone and/or joint problems

Are you currently pregnant or have you given birth in the last 6 months?

Medical History

Are you receiving treatment or taking prescribed medication for any diagnosed medical condition?

Please give brief details including any medication.

Have you had a major illness/injury or surgery in the last five years?

Please give brief details

Is your body weight 20% over your ideal body weight?

Do you suffer from high blood pressure?

Are you taking any prescription medication?

Please make sure you have responded yes to the first question on this page.

If You Answered Yes to at least one question

You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If You Answered No

If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have a low risk of having any medical complications from exercise. It is still important to start slowly and increase gradually.

In addition, could you please also answer the following:

Are you hard of hearing?

Are you visually impaired?

Please Note:

No liability is accepted for persons who undertake physical activity with undeclared pre-existing illness or injury. If in doubt, consult a medical practitioner

This PAR-Q becomes invalid should your circumstances change such that you would answer ‘Yes’ to any one of the questions set out above. Should this occur, please seek the advice of a medical practitioner before exercising, then inform your instructor.

The purpose of this PAR-Q:

To assist someone to personally assess their fitness to take part in physical exercise & to highlight areas where the advice of a medical practitioner is advised.

Actions that ATCS will take:

We will use the information provided to modify physical exercises in order to make them accessible to the participant This PAR-Q will remain paper based & will be accessible to the signatory named above. This PAR-Q is valid for one year after which time it will be replaced/destroyed. If, for any reason, the information above is amended, then the PAR-Q will be replaced & the original destroyed. Should the signatory named above leave the group permanently, then this PAR-Q will be destroyed.

Data Protection:

We will not disclose any information in this form to any third party, other than in accordance with the General Data Protection Regulation (2018) You can request a copy of the ATCS Privacy Policy or view it online on the website

Just checking if you are human