Par Q Form | Smith’s Fitness

Physical Activity Readiness Questionnaire (PAR-Q)

First name

Last name

Email

Phone

Emergency Contact Name

Emergency Contact Phone

Has a doctor ever diagnosed you with a heart condition or have you ever had a stroke?

Yes

No

Do you experience chest pain during rest or physical activity?

Yes

No

Do you feel faint, dizzy, or lose balance during exercise?

Yes

No

Have you had an asthma attack requiring emergency care in the past 12 months?

Yes

No

If you have diabetes, have you had difficulty managing your blood sugar in the past 3 months?

Yes

No

Do you have any diagnosed bone, joint, or muscle condition that may worsen with physical activity?

Yes

No

Do you have any diagnosed bone, joint, or muscle condition that may worsen with physical activity?

Yes

No

Do you have any other medical condition that may make exercise unsafe?

Yes

No

If "Yes" to any of the above, please contact a Coach to discuss.

You should consult your doctor before starting or continuing an exercise program. Share this form with them and follow their advice regarding:

• Whether you can begin unrestricted physical activity, or

• If you need supervised or modified exercise to suit your condition.

If you answered “NO” to all questions:

You can reasonably assume it is safe to begin or continue physical activity at Smith’s Fitness.

Informed Consent & Waiver - Please read each section to indicate your understanding and agreement.

1. Acknowledgement of Risk I understand that participating in physical activity at Smith’s Fitness involves inherent risks, including but not limited to: muscle soreness, fainting, abnormal blood pressure, injury, heart complications, or death.

2. Accurate Medical Disclosure I confirm that the information I have provided in this form is true and complete. I understand that medical clearance may be required and that I must notify Smith’s Fitness of any changes to my health status.

3. Right to Refuse/Withdraw I understand that I am not required to perform any exercise I do not feel comfortable with and can stop at any time. If I feel unwell or in pain, I will stop immediately and inform staff. I authorise Smith’s Fitness to seek emergency care on my behalf if needed.

4. Personal Responsibility I am confident in my ability to exercise safely and will seek coaching advice if unsure how to perform a movement or use equipment.

5. Assumption of Risk & Waiver of Liability I accept full responsibility for any injury, illness, or physical issues that may arise from participation in training at Smith’s Fitness. I release Smith’s Fitness, its staff, and affiliates from any liability.

Sign below to agree

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