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Physical Activity Readiness Questionnaire (PAR-Q)
We require that athletes and/or parents/guardians of the athletes (if athlete is under 18 years of age) complete the PAR-Q prior to participation in gymnastics. If any of the following questions are answered with a “Yes”, the athlete should be referred to a physician for further evaluation prior to participation.
Student Name
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First
Last
1. Has a doctor ever said you have a heart condition and recommended only medically supervised physical activity?
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Yes
No
2. Do you have chest pain brought on by physical activity?
*
Yes
No
3. Do you tend to lose consciousness or fall over as a result of dizziness?
*
Yes
No
4. Has a doctor ever recommended medication for your blood pressure, heart condition, or other disorder that
could influence your ability to perform gymnastics?
*
Yes
No
5. Do you have a bone or joint problem that could be aggravated by gymnastics?
*
Yes
No
6. Have you developed chest pain within the past month?
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Yes
No
7. Are you aware, through your own experience or a doctor’s advice, of any other physical reason against your exercising without medical supervision?
*
Yes
No
If so, please explain:
8. Have you ever had a neck injury, head injury or concussion?
*
Yes
No
9. Do you have a convulsive disorder?
*
Yes
No
10. Do you have uncontrolled asthma?
*
Yes
No
11. Do you have an infectious skin disorder
*
Yes
No
12. Do you have a history of a liver disorder, spleen disorder, kidney disorder or detached retina
*
Yes
No
Parent/Guardian Signature
*
First
Last
By checking this box I am confirming that all the answers are true and that my printed name as parent/guardian acts as my signature.
*
I agree
