Physical Activity Readiness Questionnaire

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Emergency Contact Details:

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Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with your doctor before you start.

If you are planning to become much more physically active than you are now, start by answering the nine questions in the box below. 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 start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Please tick all that apply.

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

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

3. Have you ever had chest pain when you have been doing physical activity?

4. Do you ever feel faint or have spells of dizziness?

5. Do you have any joint problems that could be made worse by exercise?

6. Have you ever been told you have high blood pressure?

7. Are you currently taking any medication of which the instructor should be made aware?

7a. Please provide more information

You answered yes to question 7, please advise what medication.

8. Are you pregnant or have you had a baby in the last six months? (If yes please also complete the postpartum form online.)

9. Is there any other reasons why you should not partake in physical activity?

9a. Please provide more information

You answered yes to question 9, please provide more information.

10. Is there anything the trainer needs to be aware of that isn't included in the above questions?

If you have answered YES to one or more questions

Talk to your doctor by phone or in person before you start becoming more physically active and before you have a fitness assessment.

Tell your doctor about the questionnaire and which question (s) you answered yes to. You may be able to do any activity you want – as long as you begin slowly and build up gradually, or you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kind of activity that you wish to participate in and follow his/hers advice.

If you have answered NO to all questions

You can be reasonably sure that you can start to become more physically active and take part in a suitable exercise programme. Remember begin slowly and build up gradually.

Please note if your health changes so subsequently you answer yes to any of the above questions inform your fitness or health professional immediately. Ask whether you should change your physical activity or exercise plan. Delay becoming more active if you feel unwell because of temporary illness such as cold or flu – Wait until you are better.

I have read, understood and completed this questionnaire.

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All questions have been answered to the best of my knowledge.

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I grant ‘Brawny’s Bootcamp’ full rights to use the images resulting from the photography/video filming, and any reproductions or adaptions of the images for fundraising, publicity or other purposes to help achieve the groups aims.

This might include (but not limited to), the right to use them in their printed an online publicity, social media, press and fundraising applications.

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Physical Activity Readiness Questionnaire

Your Details:

Emergency Contact Details:

Please tick all that apply.