Crossfit Deer Park Group Training Policies And Liability Release (Page 3 of 6) in pdf

Crossfit Deer Park Group Training Policies And Liability Release Page 3

Data Collection Sheet

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

Questions

1. Has your doctor ever said that you have a heart condition and that you should only perform physical activity

recommended by a doctor? Yes or No

2. Do you feel pain in your chest when you perform physical activity? Yes or No

3. In the past month, have you had chest pain when you were not performing any physical activity? Yes or No

4. Do you lose your balance because of dizziness or do you ever lose consciousness? Yes or No

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? Yes or No

6. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? Yes or No

7. Do you know of any other reason why you should not engage in physical activity? Yes or 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 NOTE: If your health changes so that you then answer YES to any of the above questions, tell your fitness

or health professional. Ask whether you should change your physical activity plan.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full

satisfaction.

Signature: _________________________

Print Name: ________________________

Date: _____________________________

Crossfit Deer Park Group Training Policies And Liability Release Page 3