PARQ | Reformed Wellness Pilates & PT

Inspire Fitness Physical Activity Readiness Questionnaire (PAR-Q)

Inspire Fitness Physical Activity Readiness Questionnaire (PAR-Q) 2023

I am aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity.
Having such knowledge, I hereby acknowledge this release, any representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

Online Disclaimer

I have enough space to workout in and ensure that I have no obstacles in the way that would cause injury. I am aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity.

Having such knowledge, I hereby acknowledge this release, any representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

All data collected on this form is treated confidential and only Inspire Fitness and/or its instructors will view this information.

First name

Last name

Email

Date Of Birth

Photographs and Videos may be taken during the session for social media & marketing purposes. Do you consent to your images being used?

YES

NO

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

YES

NO

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

YES

NO

Do you ever feel faint, have spells of dizziness or imbalance during exercise?

YES

NO

Do you have a joint problem that could be made worse by exercise?

YES

NO

Have you ever been told you have high blood pressure?

YES

NO

Are you currently taking any medication of which the instructor should be made aware of?

YES

NO

If yes what?

Are you pregnant or had a baby in the last six months?

YES

NO

Health History Do you currently receive medical care or do any of the following affect you?

Is there any other reason that you believe may prevent you from taking part in any regular activity?

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

If you have said yes to one or more questions. Please contact your doctor before becoming more physically active. Tell your doctor about the questionnaire and the question(s) you answered yes to. Talk to your doctor about the activity you wish to participate in and follow his/her advice.

Thanks for submitting!

If you have said yes to one or more questions. Please contact your doctor before becoming more physically active. Tell your doctor about the questionnaire and the question(s) you answered yes to. Talk to your doctor about the activity you wish to participate in and follow his/her advice. Please note if your health changes so that subsequently you answer ‘yes’ to any of above questions. Inform your fitness or health professional immediately. Ask whether you should change your physical activity or exercise plan. Delay becoming more active if you feel unwell because of a temporary illness such as cold and flu-wait until you are better.