1. Physical Activity Readiness Questionnaire (PAR-Q)

For most people, physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.
Common sense is your best guide in answering these few questions. Please read them carefully and check yes or no for the question if it applies to you.

1. Has your doctor ever said you have heart condition?
 Yes No

2. Do you frequently have pains in your heart and chest?
 Yes No

3. Do you often feel faint or have spells of severe dizziness?
 Yes No

4. Has a doctor ever said your blood pressure was too high?
 Yes No

5. Has a doctor ever told you that you have a bone or joint problem such as arthritis that
has been aggravated by exercise, or might be made worse with exercise?
 Yes No

6. Is there a good physical reason not mentioned here why you should not follow an
activity program even if you wanted to?
 Yes No

7. Are you over age 65 and not accustomed to vigorous exercise?
 Yes No

8. Are you currently prescribed or taking over the counter medications that will affect
your heart rate and/or blood pressure?
 Yes No

If you answered NO to all questions

If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for
an exercise program.

If you answered YES to one or more questions

Talk to your doctor by phone or in person BEFORE you start becoming more physically active or BEFORE you have fitness evaluation. Tell your doctor about the PAR-Q and which questions you answered YES.

Delay becoming more active

If you are not feeling well because of a temporary illness such as a cold or a fever, wait until you feel better;
If you are or may be pregnant, talk to your doctor before you start any physical activity.

Please note: If your health changes in a way that would cause you to answer YES to any of the above questions, inform your fitness or health professional. Ask whether you should change your physical activity plan.

2. Participant Information Form
Fields marked with asterisk (*) are required.

Personal Information

Name *

Classification *
StudentAlumniFacultyStaff

Age Range
29 years or younger30 years to 55 years50 years or older

Contact Information

Home Phone

Work Phone

Cell Phone

Email *

Client Availability

When are you available to meet with your trainer? Please list as many times as possible and be specific: (Does not require commitment)

Name of Personal Trainer Preferred

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Additional Information/Question

Copy down characters below *

State law requires that you be informed of the following:
1. with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form;
2. under sections 55.021 and 552.023 of the Government Code, you are entitled to receive and to review the information; and
3. under sections 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect."