Physical Activity Readiness Questionnaire (PAR-Q)
(A Questionnaire for People Aged 15 to 69)
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 their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven 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.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor? YesNo
Do you feel pain in your chest when you do physical activity? YesNo
In the past month, have you had chest pain when you were not doing physical activity? YesNo
Do you lose your balance because of dizziness or do you ever lose consciousness? YesNo
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? YesNo
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart con dition? YesNo
Do you know of ANY OTHER REASON why you should not do physical activity? YesNo
Talk to your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.
Text Yes
March 26, 2023
Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.
In exchange for participation in the activity of Exercise organized by Champ City, LLC, of 7308 Annette CV, Austin, Texas, 78724 and/or use of the property, facilities and services of Champ City, LLC, I, , of , , , agree for myself and (if applicable) for the members of my family, to the following:
1. AGREEMENT TO FOLLOW DIRECTIONS.
I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Champ City, LLC, or the employees, representatives or agents of Champ City, LLC.
2. ASSUMPTION OF THE RISKS AND RELEASE.
I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Champ City, LLC for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Champ City, LLC, whether caused by the fault of myself, my family, Champ City, LLC or other third parties.
3. INDEMNIFICATION.
I agree to indemnify and defend Champ City, LLC against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Champ City, LLC.
4. FEES.
I agree to pay for all damages to the facilities of Champ City, LLC caused by any negligent, reckless, or willful actions by me or my family.
5. APPLICABLE LAW.
Any legal or equitable claim that may arise from participation in the above shall be resolved under Texas law.
6. NO DURESS.
I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Champ City, LLC has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.
7. ARM'S LENGTH AGREEMENT.
This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a This is a RocketLawyer.com document. construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.
8. ENFORCEABILITY.
The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.
9. EMERGENCY CONTACT.
In case of an emergency, please call (Relationship: ) at (Day), or (Evening).
I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
Leave this empty:
Your legal name
Your email address
Click on "Agree & Sign" to legally sign this document and agree to the WP E-Signature Terms of Use. If you have questions about the contents of this document, you can email the document owner.
Document Name: Physical Activity Readiness Questionnaire (PAR-Q)
Click on "Agree & Sign" to legally sign this document and agree to the WP E-Signature Terms of Use.
Agree & Sign
