Physical Activity Readiness Questionnaire (PAR-Q)

Name of student *

First Name

Last Name

Student date of birth *

MM

DD

YYYY

Name of parent/guardian *

First Name

Last Name

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

Yes (if so, please state details in the box at the bottom)

No

Do you feel pain in your chest when you do physical activity? *

Yes (if so, please state details in the box at the bottom)

No

In the past month, have you had a chest pain when you were not doing physical activity? *

Yes (if so, please state details in the box at the bottom)

No

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

Yes (if so, please state details in the box at the bottom)

No

Do you have a bone or joint problem (for examples back, knee or hip) that could be made worse by a change in your physical activity? *

Yes (if so, please state details in the box at the bottom)

No

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

Yes (if so, please state details in the box at the bottom)

No

Do you have any current or pre-existing injuries? *

Yes (if so, please state details in the box at the bottom)

No

Do you know of any other reason why you should not take part in physical activity? *

Yes (if so, please state details in the box at the bottom)

No

I, the parent/guardian of the athlete, consent for my child to undergo performance testing with Bespoke Conditioning and agree that any exercise is undertaken willingly and free from injury. Any injuries occurring during the programme are at their own risk. *

I agree

I give consent for my child to have photos/videos taken of them when training for social media marketing purposes.

Yes

No

I'd like to be kept up-to-date with Bespoke Conditioning's new equipment for testing & our new features to The Pathway, via their mailing list (we won't be popping up in your inbox any more than once a month)

Yes please, that sounds great

No thanks