Waiver/ PAR-Q — Abstract Athletics

Name

First Name

Last Name

Question

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

Yes

Qestion

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

Yes

Question

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

Yes

Question

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

Yes

Question

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

Yes

Question

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

Yes

Question

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

Yes

Explain

Question

Does your occupation require extended periods of sitting?

Yes

Question

Does your occupation require repetitive movements? (If YES, please explain.)

Yes

Explain

Question

Does your occupation cause you mental stress?

Yes

Explain

Question

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If YES, please explain.)

Question

Do you have any additional hobbies (reading, video games, etc.)? (If YES, please explain.)

Question

Have you ever had any injuries or chronic pain? (If YES, please explain.)

Question

Have you ever had any surgeries? (If YES, please explain.)

Question

Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease,hypertension, high cholesterol, or diabetes? (If YES, please explain.)

Question

Are you currently taking any medication? (If YES, please explain.)

Checkbox

Personal Training will involve various activities, including but not limited to, Pushing, Pulling, Hanging, yoga, stretching external loaded lifts, jumping skipping, hopping,animal movements,punching & kicking. Some of these involve strenuous exertions of the cardiovascular and muscular systems and muscular strength using various muscle groups. You should never force or strain during these activities. If you experience any pain or discomfort, you should immediately Stop & Tell your insctructor & possibly consult with a physician or other licensed medical provider. By participating in this Personal Training you acknowledge, understand, and assume these inherit risks, and all risks, known or unknown and waive negligence claims related in any way to the exercise programs and workout equipment or Instructor & agree all medical clearances have been received by the your primary healthcare provider. Personal Training is intended only for persons who are in good health, and who are not pregnant or suffering from an illness or disability. The Program is not designed to, and should not be interpreted by you as, providing any medical advice. If you experience any medical issues or have any medical concerns, you should immediately consult with a physician or other licensed medical provider.

I have read & agree to above statement & all info submitted is true to best of my knowledge

Physical Atcivity Readiness questionaire

Athletics

Apply Your Mind

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