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Fitness Waiver and PAR Q

Please submit prior to your first class

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.


If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start.

If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. Please read the questions carefully and answer each one honestly:

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Do you feel pain in your chest when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

Plese select Yes or No:

If you answered YES to any of the above questions, talk with your doctor by phone or in person BEFORE you start becoming much more physically active. Tell your doctor about the PAR-Q and which questions you answered YES.

  • You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you.  

  • Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

  • start becoming much more physically active – begin slowly and build up gradually. This is the

    safest and easiest way to go.

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

I have read, understand, and accept the following:

When participating in any exercise program, there is the possibility of physical injury. By entering a virtual fitness session with Andrea Sereda and Journey Health Studio, and choosing to engage in the exercise program provided, I agree that I do so at my own risk, and voluntarily participate in these activities, assume all risk of injury to myself, and those around me. I am responsible for my surroundings and ensuring I have a safe space to participate, safe and appropriate clothing, footwear and flooring. I agree to release and discharge the instructors involved from any and all claims, causes of action or injury arising out of this exercise. All classes offered are intended for adults 18+. Anyone under the age of 18 participating in these virtual classes must do so under the supervision of a participating adult. The participating adult assumes full responsibility for the safety and any resulting injury of all minors. 

Thank you for completing and submitting!

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