PAR-Q Questionnaire - Royal Resistance

Your General Health

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

Yes
No

Have you ever felt pain in your chest when you do physical exercise?*

Yes
No

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

Yes
No

Do you often feel faint, have spells of severe dizziness or have lost consciousness?*

Yes
No

Have you ever suffered from unusual shortness of breath at rest or with mild exertion?*

Yes
No

Has your doctor ever said that you have a bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise?*

Yes
No

Do you have high blood pressure?*

Yes
No

Do you have low blood pressure?*

Yes
No

Are you currently on any prescribed medicines that may affect your ability to exercise?*

Yes
No

Please give details of any prescribed medication that may affect your ability to exercise

Are you pregnant or have you had a baby in the last 6 months (females only)?*

Yes
No
n/a

Do you know of any other reason that would affect your ability to participate in physical activity?*

Yes
No

Please give details of any reason that would affect your ability to participate in physical activity

I give permission Royal Resistance permission to use pictures/videos for social media and web site content.*

Yes
No

If you answered YES to one or more questions

You should talk to your doctor either in person or by phone before you start becoming more physically active and/or take a fitness appraisal. Tell your doctor what questions you answered yes to on this form.

You may still be able to do any activity you want as long as you start slowly and build up gradually or it may be that you need to restrict your activities to those which are safe for you.

Your Details

Full Name and Childs Name*

Date*

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 boxing, combat sports, aerobic exercise, resistance exercise and stretching. 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.

Yes I’ve read and agree to the Royal Resistance Privacy Policy