Physical Activity Readiness Questionnaire (PAR-Q) : Gavia Kimberly Ruth Doble

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Physical Activity Readiness Questionnaire (PAR-Q)

Doble Kimberly Ruth


Name:___________________________________________________________ ✓
Gavia Gender :______Male _________Female
Last First MI
18-11358-808
Student Number_____________________________________________ Coure, Year and Section:________________
BS PSYCH 2-YA-4

Contact number: ________________________


09205446043 / 09433056216 Email: _____________________
[email protected] Date: _________________
September 08, 2021

For the majority of people, physical activity should not be the reason of danger or injury to the performer. PAR-
Q has been designed to identify whether the person is physical fit or not for a strenuous activity.

Truthfulness is your best guide in answering these few questions. Please read them carefully and check yes or
no for the question if it applies to you.

Yes__ No__
✓ 1. Has your doctor ever said you have a heart problem?

Yes__ No__
✓ 2. Do you frequently have pains in your heart and chest?

Yes__ No__
✓ 3. Do you often feel faint or have spells of severe dizziness?

Yes__ No__
✓ 4. Has a doctor ever said your blood pressure was too high?

Yes__ No__
✓ 5. Has a doctor ever told you that you have bone or joint problem such as arthritis that has

been aggravated by exercise, or might be made worse by exercise?

Yes__ No__
✓ 6. Is there a good physical reason not mentioned here why you should not follow an activity

program even if you wanted?

Yes__ No__
✓ 7. Are currently prescribed or taking over the counter medication that will affect your heart
rate

and/ or blood pressure?

Yes__ No__
✓ 8. Do you have injury or undergone operation before?

Yes__ No___
✓ 9. Do you have experienced shortness of breath?

Yes__ No__
✓ 10. Do you have an asthma or something alike to this ailment?

If you answered No to all questions…..

If you answered PAR-Q precisely, you are holistically ready for the physical activities.

If you answered YES to one or more questions…..

If you have not recently done so, consult with your personal physician by telephone or in person before joining
the physical activity and/ or taking a fitness test.
Provide information for questions that you answered “yes”.

No. Incident/Problem Date Reported

________________________________
KIMBERLY RUTH G. DOBLE ____________________________________
RUBY G. DOBLE

Signature over Printed name: Signature over Printed name:


Student Guardian

Please attach ID with signature of guardian.

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