PAR-Q | Boulder Strength

Name *

First

Last

Email *

Who is your emergency contact? *

First

Last

Emergency contact phone *

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

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

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

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

Do you lose balance because of dizziness or do you ever lose consciousness? *

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? *

Do you know of any other reason why you should not take part in physical activity? *