Group Training Registration ZZ - Group Training Registration First Name * Last Name * Username * (This is the name that will be publicly viewable) Email * Experience Level * Beginner: 0 - 6 monthsIntermediate: 6 - 24 monthsAdvanced: > 24 months 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 qualifed exercise professional before becoming more physically active. Has your doctor ever said you have a heart condition or high blood pressure? * Yes No Do you feel pain in your chest at rest, during your daily activities of living OR when you do physical activity? * Yes No Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? * Yes No (Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise)) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? * Yes No Please List Condition(s) Here Are you currently taking prescribed medications for a chronic medical condition? * Yes No Please List Chronic Condition(s) and Medications (with doses) Do you currently have (or have had within the past 12 months) a bone, joint or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? * Yes No (Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active) Please List Injuries Below Has your doctor ever said you should only do medically supervised physical activity? * Yes No Go to top I, the undersigned, have read, understood to my full satisfaction and completed the PAR-Q+ online form. I have answered each question truthfully, reflecting my current condition. I acknowledge that this physical activity clearance/recommendation is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that a Trustee (such as my employer, community/fitness centre, health care provider, or other designate) may maintain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that they maintain the privacy of the information and not misuse or wrongfully disclose such information. The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who undertake physical activity. If in doubt after completing the questionnaire, consult your doctor prior to physical activity. Signature * signature keyboard Clear Digitally Signed * Submit
