If you answered NO to all of the questions above, you are cleared for physical activity. Please sign the PARTICIPANT DECLARATION. You do not need to complete Pages 3 and 4. Start becoming much more physically active – start slowly and build up gradually. Follow International Physical Activity Guidelines for your age (www.who.int/dietphysicalactivity/en/). You may take part in a health and ftness appraisal. If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal efort exercise, consult a qualifed exercise professional before engaging in this intensity of exercise. If you have any further questions, contact a qualifed exercise professional.
If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form. I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/ftness centre may retain a copy of this form for records. In these instances, it will maintain the confdentiality of the same, complying with applicable law.
Delay becoming more active if: You have a temporary illness such as a cold or fever; it is best to wait until you feel better. You are pregnant – talk to your health care practitioner, your physician, a qualifed exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active. Your health changes – answer the questions on Pages 2 and 3 of this document
If you answered NO to all of the FOLLOW-UP questions (pgs. 2-3) about your medical condition, you are ready to become more physically active – sign the PARTICIPANT DECLARATION below: It is advised that you consult a qualified exercise professional to help you develop a safe and effective physical activity plan to meet your health needs. You are encouraged to start slowly and build up gradually – 20 to 60 minutes of low to moderate intensity exercise, 3-5 days per week including aerobic and muscle strengthening exercises. As you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical activity per week. If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.
If you answered YES to one or more of the follow-up questions about your medical condition: You should seek further information before becoming more physically active or engaging in a fitness appraisal. You should complete the specially designed online screening and exercise recommendations program – the ePARmed-X+ at www.eparmedx.com and/or visit a qualified exercise professional to work through the ePARmed-X+ and for further information.
Delay becoming more active if: You have a temporary illness such as a cold or fever; it is best to wait until you feel better. You are pregnant – talk to your health care practitioner, your physician, a qualifed exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active. Your health changes – answer the questions on Pages 3 and 4 of this document
You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO changes are permitted. The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who undertake physical activity and/or make use of the PAR-Q+ or ePARmed-X+. If in doubt after completing the questionnaire, consult your doctor prior to physical activity.
All persons who have completed the PAR-Q+ please read and sign the declaration below. If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form. I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/fitness center may retain a copy of this form for records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.
