PAR-Q: Physical Activity Readiness Questionnaire Email * Name * First Name Last Name Date Today * MM DD YYYY Date of Birth * MM DD YYYY Phone (###) ### #### Please answer the following questions: Tick all boxes that apply. Has your doctor ever said you have a heart condition and should only perform physical activity recommended by a doctor? Do you feel pain in your chest when performing physical activity? Have you experienced chest pain when not performing physical activity in the last month? Do you lose your balance due to dizziness or have you lost consciousness recently? Do you have bone or joint problems that could be made worse by physical activity? Is your doctor currently prescribing medication for high blood pressure or a heart condition? Have you had an operation in the last 12 months? Is there any reason why you should NOT participate in physical activity? If you have answered YES to any of he above: You should speak to your GP / Medical Professional before taking part in this activity and ask for information about specific exercise limitations you may have. In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines. Please give more information and confirm you have received permission from your medical professional to take part in this activity: Medical Clearance Received (If Yes to any of the above) Yes No Declaration * I confirm that I am voluntarily engaging in an acceptable level of exercise and understand the risks involved. I confirm Photo Release Waiver * “Hibiscus Kin Ltd.” (HK Ltd.) would like to use your images (photographs), video recordings and/or audio for possible internal and external promotion of their work. The photography/video/audio could be used in print and digital media formats, including (but not restricted to) print publications, websites, e-marketing, poster banners, advertising, film, social media, teaching and research purposes, either in an edited or non-edited format. Your image/s will only be used for the purposes of promoting HK Ltd, not for any other purpose. We will not pass your data on to a third party. I consent to the use of my photo/video/audio for promotional purposes. I do NOT consent to the use of my photo/video/audio. I am at least 18 years of age. I am under 18 but have guardian consent. Thank you!
