((BOUNCE))™ Physical Activity Readiness Questionnaire


Physical Activity Readiness Questionnaire  (PAR-Q Form)

Participation in ((BOUNCE))™ is very safe for most people. However, some people should check with their doctors before they begin physical activity of any type. If you are planning to become much more physically active than you are now, start by answering the seven questions below.

Please read the questions carefully and answer each one honestly; YES or NO

Questions:
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?
7. Do you know of any other reason why you should not do physical activity?

If you answered YES to one or more questions:
Talk with your doctor by phone or in person before you start becoming more physically active. Tell your doctor about the PAR-Q and to which questions you answered YES. You may still 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 ((BOUNCE))™ which is also formally known as ‘rebounding’ and follow his/her advice. Participation in ((BOUNCE))™ is only allowed if an attendee has their doctor’s medical approval – see our T&C’s for more information.


If you answered NO to all PAR-Q questions:
You can be reasonably sure that you can participate in our exercise program – begin slowly and build up gradually, just like with anything new your body needs to get used to it. Always discuss any concerns before a class starts with the instructor.

Delay becoming more physically active if:
• 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 new exercise regime.
• If you have recently given birth and have any medical considerations - talk to your doctor before you start any new exercise regime.
• If your health changes so that you answer YES to any of the above questions, tell your doctor and ask their medical advice.

 

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

 

Name                           ________________________________________

Signature                    ________________________________________

Date                            ________________________________________