Waiver

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

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

Yes
No

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

Yes
No

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

Yes
No

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

Yes
No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?*

Yes
No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?*

Yes
No

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

Yes
No

If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. Please explain any "YES" answers in the space below. If you did not answer "YES" to any questions, put N/A. *A response is required.

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. 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. • Find out which community programs are safe and helpful for you. 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. If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can: • start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go. • take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active. NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes. Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity. I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Accept*

Yes

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PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)