PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q) AND INFORMED CONSENT

You will need to complete this form before your first lesson with us. You will be asked to complete a new form each year and if your condition changes so that you could answer YES to any of the questions included on the PAR-Q.

this FORM SHOULD TAKE YOU LESS THAN 5 MINUTES TO COMPLETE.

Don’t forget to hit the “complete” button when you are done to send us your form!


Name *
Name
Date of Birth *
Date of Birth
Please include their name and contact number
PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)
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 SIGNIFICANTLY CHANGE YOUR PHYSICAL ACTIVITY PATTERNS. IF YOU ARE OVER 69 YEARS OF AGE AND ARE NOT USED TO BEING VERY ACTIVE, CHECK WITH YOUR DOCTOR. COMMON SENSE IS YOUR BEST GUIDE WHEN ANSWERING THESE QUESTIONS. PLEASE READ THEM CAREFULLY AND ANSWER HONESTLY.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you take part in physical activity? *
In the past month, have you had a chest pain when you were not doing physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a diagnosed bone or join problem (for example: back, knee or hip) that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing medication for a blood pressure or heart condition? *
Are you pregnant or did you have a baby within the last year? *
Do you know any other reason why you should not do physical activity
IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS: PLEASE CHECK WITH YOUR DOCTOR BEFORE YOU BECOME OR INCREASE YOUR PHYSICAL ACTIVITY.
Please select ONE *
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in exercise and that my participation involves some risk of injury.
I further understand that pilates is exercise and should not be considered or take the place of medical advice/treatment.
Date
Date
INFORMED CONSENT
I understand that my pilates lessons at bePilates include exercises to build up the cardio-respiratory system, the musculoskeletal system and to improve body composition. Exercises may include aerobic activities, calisthenic exercises and resistance training to improve muscular strength and endurance. Flexibility exercises are included to improve joint range of motion. I understand that the reaction to the body cannot always be predicted with accuracy. I understand that bePilates and its agents shall not be liable for any damages arising from personal injuries I may sustain throughout my practice with them. I participate at my own risk and assume full responsibility for any injuries or damages that may occur during or following my lesson. I will let my teacher know if I experience any pain during or after a lesson, which is not typical muscular pain that is common when working out and acknowledge that they may ask me to refrain from practice until I have sought medical advice. I hereby fully and forever release and discharge bePilates and its agents from all claims, demands, damages, rights of action, present and future therein. I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety and comfort, or physical condition when I engage or participate in pilates lessons.
Date
Date