PARQPhysical Activity Readiness Questionaire (PARQ)Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Date of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email *EmailConfirm EmailAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeExercise Goals *Weight LossTone UpHealth ReasonsWeight/Strength TrainingCardio ImprovementOtherHave you ever had or suffered from any of the following?Heart DiseaseRespiratory DiseaseHigh Blood PressureStrokeArthritisEpilepsyCancerDiabetesOsteoporosisFibromyalgiaFainting/DizzinessBone/Joint ProblemsBack ProblemsMuscle DamageMajor SurgeryIf you answered 'Yes' you must seek consent to train from your GP.Are you pregnant? (Women only)YesNoEmergency Contact *FirstLastPlease enter the details of the person to be contacted in case of emergencySubmit Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)