Event Rider Fitness PARQ

PARQ & Contact Form

The Physical Activity Readiness Questionnaire is designed to determine an individual's safety when starting a new exercise plan.

Please answer as honestly as possible!

First Name *

Last Name *

Phone *

Street Address *

Town / City *

State / County *

Postal code *

Country *

Date of birth *

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship *

1. Has your doctor ever said that you have a heart condition & recommended only medically supervised activity? *

2. Do you have chest pains brought on by physical activity? *

3. Have you developed chest pains in the last month? *

4. Do you tend to lose consciousness or fall over as a result of dizziness? *

5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity? *

6. Has a doctor ever recommended medication for your blood pressure or heart condition? *

7. Are you currently pregnant? *

If you have answered YES to any of these questions, please provide details below

I hereby state I have read, understood & answered honestly to the questions above. I understand participation in exercise involves the risk of injury & Katie will not be held liable. *

PARQ & Contact FormThe Physical Activity Readiness Questionnaire is designed to determine an individual's safety when starting a new exercise plan.

Please answer as honestly as possible!

PARQ & Contact Form

The Physical Activity Readiness Questionnaire is designed to determine an individual's safety when starting a new exercise plan.