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Revival Personal Training Ltd - PAR-Q

PHYSICAL ACTIVITY & RECOVERY STUDIO READINESS QUESTIONNAIRE

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change you physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Please read each question carefully and answer honestly by indicating YES or NO.

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

Do you know of any other reason why you should not take part in physical activity? If YES, please answer why...

This PAR Q becomes invalid if your condition changes so that you would answer YES to any of the 7 questions. If you answered YES to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active and/or undertake treatments and activities related to the sauna and ice bath at this current time and in your current state of health. If you answered NO to one or more questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal with your Trainer can help determine your ability levels. Assumption of Risk I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include (but is not limited to) aerobic exercise, resistance exercise, stretching with my Trainer, ice bath usage, sauna usage, physiotherapy and massage. The type of training and location of the exercise I perform is entirely the choice of my Trainer and I release Revival Personal Training Ltd of all liability for my participation in these activities. Usage & participation in any activities related to physiotherapy, massage, sauna or ice bath is entirely my own choice and I release Revival Personal Training Ltd of all liability for my participation in these activities. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me by my Trainer.