Physical Activity Readiness Questionnaire (PAR-Q)

Your Name (required)

Date of Birth *

Full Address *

Have you had any of the following (tick all that apply): Please read carefully *
Heart problemsJoint problemsFainting spellsEpilepsyPain in the chest when exercisingBack complaintsHigh blood pressureLow blood pressureAre you on any medication?DiabetesAny breathing difficulties/asthmaAre you pregnantAny other significant illness, recent or serious operations

If yes, please give details:

If you have answered yes to any of the above questions, you should consult your doctor for advice. If any of the above changes in the future, please inform your fitness instructor immediately. The above questionnaire has been devised to aid you in assessing your state of health before commencing your workout.

Informed Consent
I wish to embark on a programme of physical activity including weight training and the use of various aerobic conditioning machinery. I hereby affirm that I do not suffer from any condition which prevents my participation in an exercise programme.
I hereby release my trainer from any claims, demands and causes of action arising from my participation in this exercise programme, I agree to abide by the conditions of use as stated in this document.
I fully understand that should I injure myself as a result of exercise participation, I hereby release my trainer from any liability now or in the future.

Signed (Type Name) *

Signed Date *