PAR-Q

Name

Email

Phone Number

Address

Age

Height

Weight

Emergency Contact Name

Emergency Contact Number

Chest pain at rest or on exertion?
—Please choose an option—yesno

Do you have diabetes?
—Please choose an option—yesno

Do you have epilespsy?
—Please choose an option—yesno

Do you have asthma?
—Please choose an option—yesno

Do you have back pain or joint problems?
—Please choose an option—yesno

Are you pregnant or recently given birth?
—Please choose an option—yesno

Please list any other conditions that may affect your ability to exercise?

Are you moderately active on most days of the week?
—Please choose an option—yesno

Have you done any strength training in the past?
—Please choose an option—yesno

Are your stress levels high?
—Please choose an option—yesno

Do you drink alcohol on more than 3 days a week?
—Please choose an option—yesno

What are your main reasons for starting a strength and conditioning programme?

To the best of my knowledge the above information is true?
—Please choose an option—yesno