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Physical Activity Readiness Questionnaire (PARQ)

Sign Date: May 2, 2026

First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Third Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Fourth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Fifth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Sixth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Seventh Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Eighth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Ninth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Tenth Participant's Name
First Name*
Last Name*
Select Gender
Participant's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Information
Occupation:
Have you ever suffered from heart trouble?*
No
Yes
Are you presently taking any form of medication?*
No
Yes
Do you suffer from chest pains?*
No
Yes
Do you ever have spells of dizziness or feel faint?*
No
Yes
Have you ever had either high or low blood pressure, and/or high cholesterol level?*
No
Yes
Have you ever had asthma, chronic bronchitis or any other chest ailments?*
No
Yes
Do you suffer from severe back pains or any orthopaedic problem?*
No
Yes
Do you suffer from severe headaches or migraines?*
No
Yes
Are you recuperating from a recent illness/operation or injury?*
No
Yes
Have you any medical condition that i should be aware of?*
No
Yes
Are you pregnant? If yes how many months?*
No
Yes
Is there any history of heart disease in your immediate family (under the age of 55)?*
No
Yes

Medical history

PLEASE NOTE: If you answered YES to any of questions 1 to 12, you are advised to seek medical advice/approval before commencing any exercise session.

I have been informed both verbally and in writing that if I answer YES to any of questions 1 to 12 of this questionnaire, I should seek medical advice/approval before commencing an exercise session. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered the above questions honestly. I understand that the instructor cannot be held responsible for any injuries or ill health of any kind arising following the attendance of this session.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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