Physical Readiness Activity Questionnaire

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program.

Please answer all questions accurately and honestly to allow us to fully determine your individual needs.

Date*

Email

First Name

Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Mobile Number

Gender

Age

Height

Weight

Do you have high cholesterol?

Yes
No

Has your doctor ever said that you have heart trouble?

Yes
No

Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?

Yes
No

Has your doctor ever told you that your blood pressure was too high?

Yes
No

Are you over 65 years of age and not accustomed to vigorous exercise?

Yes
No

Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?

Yes
No

The following information will be treated as privileged

Do you ever feel weak, fatigued, or sluggish?

Yes
No

Do you need several cups of coffee to keep you going throughout the day?

Yes
No

Do you often experience digestive difficulties?

Yes
No

How long have you been exercising?

Are you happy with the way you look and your health?

Yes
No

On a scale of 1 to 10, how serious are you about achieving your goals?

Please list your desired goals:

Desired Weight:

Desired Size:

How many times a week you can commit to training to reach your goal?

BUYER ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF GRANT HENSON BODY TRANSFORMATION

BUYER ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER BUYER’S PARTICIPATION IN THE PHYSICAL ACTIVITES. BUYER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT AR NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BUYER, SLIP AND FALL BY BUYER, OR AN UNKNOWN HEALTH PROBLEM OF BUYER. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, BUYER AFFIRMS THAT BUYER IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYISCAL ACTIVITIES. BUYER ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND BUYER AGREES THAT IT IS THE RESPONSIBILITY OF BUYER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF BUYER TO TAKE PART IN . PHYSICAL ACTIVITIES. BY CHECKING THE BOX BELOW THIS AGREEMENT, BUYER ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.

Check This Box to Agree The Above Disclaimer*

I Agree

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Email

This field is for validation purposes and should be left unchanged.

PHYSICAL ACTIVITY READINESS

The following information will be treated as privileged

your privacy is protected