PT PAR-Q

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PT PAR-Q

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Regular physical activity is fun, safe and healthy for almost everyone. However, some people may have health related risk factors that may be aggravated by participation in a physical activity program and should check with their doctor before they start a program or become more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. 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 start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.Please read the questions carefully and answer each one honestly: check YES or NO. All information will be kept confidential.

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

Yes

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

Yes

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

Yes

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

Yes

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? *

Yes

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

Yes

Do you know of any other reason why you should not do physical activity? *

Yes

If you answered YES to one or more questions:

It is recommended to talk with your doctor by phone or in person BEFORE you start a program or become much more physically active. Tell your doctor about the PAR-Q and which questions you answered YES.

- You may be able to do any activity you want—as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

Delay becoming much more active:

- If you are not feeling well because of a temporary illness such as a cold or a fever—wait until you feel better; or

- If you are or may be pregnant—talk to your doctor before you start becoming more active.

Please note: If your health changes so that you then answer YES to any of the above questions, tell Callum Gomersall and consult your Doctor. Ask whether you should change your physical activity plan.

I desire to engage voluntarily in training with CG Fitness in order to improve my physical fitness. I understand that the purpose of the sessions are to improve my fitness levels through cardio, weights and other methods. I understand that I am responsible for monitoring my own condition throughout the exercise program and should any unusual symptoms occur, I will cease my participation and inform the instructor of the symptoms. In signing this consent form, I will affirm that I have read this form in its entirety and that I understand that the nature of the exercise program. I also affirm that my questions regarding the sessions have been answered to my satisfaction. Also in consideration for being allowed to participate in the program, I agree to assume the risk of such exercise, and further agree to hold harmless CGFitness - Callum Gomersall from any and all claims suits, losses or related causes of action for damages, including but not limited to, such claims that may result from my injury or death, accidental or otherwise, during or arising in any way from the exercise program.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. *

I Consent to the terms outlined in this form

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