HOUSE OF SK-1 - PHYSICAL ACTIVITY READINESS FORM (PAR-Q)
Name
Address
Phone Number
Email
Date of birth
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Please tick all that apply
I have a heart condition and I should only do physical activity recommended by a doctor
I feel pain in my chest when I do physical activity
In the past month, I have had chest pain when I was not doing physical activity
I lose my balance because of dizziness or sometimes lose consciousness
I have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in my physical activity
I am currently taking medication (for example, water pills) for your blood pressure or heart condition
There is another reason why I should NOT do physical activity - see additional details
I am pregnant or have given birth in the last 3 months - please provide additional details
I am fit to exercise
Additional details
Long text
If you answered YES to any of the first 7 questions, you may need approval from your doctor BEFORE you start becoming more physically active and BEFORE you attend a session at THE HOUSE OF SK-1. Tell your doctor about the PAR-Q and which questions you answered YES.<br><br>If you answered NO honestly to the first 7 PAR-Q questions, you can be reasonably sure that you can start becoming much more physically active.<br><br>PLEASE NOTE: If your health changes so that you then answer YES to any of the first 7 questions, tell your fitness or health professional. Ask whether you should change your physical activity plan and consult your doctor.
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