Strength Ritual PAR-Q Form

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Strength Ritual PAR-Q Form

Thank you for joining Strength Ritual. Before we begin, please take a few minutes to complete this form. Your responses help ensure that your program is safe, effective, and tailored to your needs.

This form has three main sections:

Health & Readiness (PAR-Q) – These questions summarize your medical history, current physical condition, and any considerations for your safety during the program.
Personal Goals – Let me know what you’d like to achieve. Strength Ritual focuses on mindful strength, balance, and confidence. Goals aren’t just about weight!
Waiver & Consent – By completing this form, you acknowledge the risks associated with physical activity and agree to participate responsibly.

Please answer all questions honestly. If you have any concerns, consult your healthcare provider before participating. Your privacy is important; your information will only be used for Strength Ritual purposes.

Once completed, you’ll be all set to start tracking your progress and moving toward your goals. Thank you for taking the time to complete this form. Your safety and success are top priority!

Participant Name: *

Date of Birth: *

YYYY

Email: *

Phone: *

Medical History:
Have you ever been diagnosed with or experienced any of the following? (Check all that apply) *

High blood pressure

Heart Condition

Stroke

Breathing/lung issues (asthma, COPD)

Joint or musculoskeletal issues (arthritis, chronic pain, injuries)

Diabetes

Balance or dizziness problems

Neurological conditions (e.g., concussion, stroke, MS, Parkinson’s)

None of the above

Other:

Required

Do you currently experience any of the following?

Chest pain or discomfort during activity

Shortness of breath at rest or with mild activity

Dizziness or fainting

Unusual fatigue during normal activity

Pain, swelling, or injury that limits movement

None of the above

Required

Are you currently taking any medications that may affect your ability to exercise safely? If not, please simply indicate "No" below. *

Has your doctor ever told you not to participate in physical activity? *

Yes

Do you feel safe to participate in a moderate strength/movement program? *

Yes

What are your goals for Strength Ritual? (Check all that apply or add your own)

Increase strength and functional fitness

Improve flexibility and mobility

Enhance balance and coordination

Reduce aches, pains, or stiffness

Build confidence in movement

Establish a mindful movement routine

Other:

Required

Emergency Contact (Name, Phone Number, Relationship): *

Participant Waiver & Consent:

I understand that Strength Ritual involves physical activity, including strength and movement exercises. I acknowledge that participation may involve some risk of injury. I confirm that I am physically able to participate or have consulted a medical professional regarding my participation.

By signing this form, I agree to:

-Participate at my own risk.

-Release and hold harmless Carey Lyn Carty/Drop Anchor Studio, its instructors, and staff from any liability, injury, or loss arising from my participation.

-Follow all safety instructions provided during sessions.

I have read, understood, and agree to the above. Type your full name here to acknowledge and agree to the waiver above.

Today's date: *

YYYY

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