Scribd
Upload
4 views

Physical

Uploaded by

d o n t p l e a s e
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
4 views

Physical

Uploaded by

d o n t p l e a s e
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

School of Arts and Sciences

Physical Education Department


2nd term, Academic Year 2024 – 2025

DATA COLLECTION
Name: ___________________________________ Date: ________________
Course & Section: __________________________ Class Schedule: ________________

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

The health benefits of regular physical activity are clear; more people should engage in
physical activity every day of the week. Participating in physical activity is very safe for
MOST people. This questionnaire will tell you whether it is necessary for you to seek further
advice from your doctor OR a qualified exercise professional before becoming more
physically active.

Please read the 7 questions below carefully and answer each one
YES NO
honestly: check YES or NO.
1. Has your doctor ever said that you have a heart condition and that you
should only perform physical activity recommended by a doctor?
2. Do you feel pain in your chest when you perform physical activity?
3. In the past month, have you had chest pain when you were not
performing any physical activity?
4. Do you lose your balance because of dizziness, or do you ever lose
consciousness?
5. Do you have a bone or joint problem that could be made worse by a
change in your physical activity?
6. Is your doctor currently prescribing any medication for your blood
pressure or for a heart condition?
7. Do you know of any other reason why you should not engage in
physical activity?

Note: 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.
MEDICAL QUESTIONNAIRE

Medical Questions: Yes or No


1. Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? (If
yes, please explain.)

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

3. Has a medical doctor ever diagnosed you with a chronic disease, such as coronary
heart disease, coronary artery disease, hypertension (high blood pressure), high
cholesterol or diabetes? (If yes, please explain.)

4. Are you currently taking any medication? (If yes, please list.)

Note: You must use the entire questionnaire and NO changes are permitted. If in doubt after
completing the questionnaire, consult your doctor prior to physical activity.

PARTICIPANT DECLARATION
 All students who have completed the PAR-Q please read and sign the declaration
below.
 If you are less than the legal age required for consent or require the assent of a care
provider, your parent, guardian, or care provider must also sign this form.

I, the undersigned, have read, understood to my full satisfaction, and completed this
questionnaire. I acknowledge that this physical activity clearance is valid for this term from
the date it is completed and becomes invalid if my condition changes. I also acknowledge
that the community/fitness center may retain a copy of this form for records. In these
instances, it will maintain the confidentiality of the same, complying with applicable law.

Name of student: ____________________________ Date: _____________________


Signature of student: _________________________
Name of Parent/Guardian/ Care Provider: __________________________________
Signature of Parent/Guardian/Care Provider: ________________________________

You might also like