2021 PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone. Mandatory before participating in Revival Fitness services.

Has your doctor ever said that you have a heart condition OR high blood pressure?
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? (please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise))
Have you ever been diagnosed with another chronic medical condition (other that heart disease of high blood pressure)?
Are you currently taking prescribed medications for chronic medical condition?
Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? (Please answer NO if you had a problem in the past, but does not limit your current ability to be physically active)
Has your doctor ever said that you should only do medically supervised physical activity?

If you answered NO to all of the questions above, you are cleared for physical activity. Please sign the PARTICIPANT DECLARATION. 

PARTICIPANT DECLARATION

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 centre may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with the applicable law.

If you answered YES to one or more of the questions above, you will need to COMPLETE PAGES 2 AND 3.

A PDF will be provided to you through your email address were you will need to fill it out and submit it to Revival Fitness. Please submit the form and await further instructions.

Thanks for submitting!