Physical Activity Readiness Questionnaire (PAR-Q)

Name:____Albert P. Porton__________________________________ Gender :__√___Male _________Female

Last First MI
Student Number_______02210003573__________ Coure, Year and Section:____BSCMM 2-YB-3____

Contact number: __09366969709___________ Email: albertporton@gmail.com_ Date: Feb. 26, 2023

For the majority of people, physical activity should not be the reason of danger or injury to the performer.
PAR-Q has been designed to identify whether the person is physical fit or not for a strenuous activity.

Truthfulness is your best guide in answering these few questions. Please read them carefully and check yes or
no for the question if it applies to you.

Yes__ No_✓_ 1. Has your doctor ever said you have a heart problem?

Yes__ No_√_ 2. Do you frequently have pains in your heart and chest?

Yes__ No_√_ 3. Do you often feel faint or have spells of severe dizziness?

Yes__ No_√_ 4. Has a doctor ever said your blood pressure was too high?

Yes__ No_√_ 5. Has a doctor ever told you that you have bone or joint problem such as arthritis that has

been aggravated by exercise, or might be made worse by exercise?

Yes__ No_√_ 6. Is there a good physical reason not mentioned here why you should not follow an activity

program even if you wanted?

Yes__ No_√_ 7. Are currently prescribed or taking over the counter medication that will affect your heart
rate

and/ or blood pressure?

Yes__ No_√_ 8. Do you have injury or undergone operation before?

Yes__ No_√__ 9. Do you have experienced shortness of breath?

Yes__ No_√_ 10. Do you have an asthma or something alike to this ailment?

If you answered No to all questions…..

If you answered PAR-Q precisely, you are holistically ready for the physical activities.

If you answered YES to one or more questions…..

If you have not recently done so, consult with your personal physician by telephone or in person before
joining the physical activity and/ or taking a fitness test.

Provide information for questions that you answered “yes”.

No. Incident/Problem Date Reported

_____PORTON, ALBERT P._______________. PORTON, RAUL A.

Signature over Printed name: Signature over Printed name:

Student Guardian
Please attach ID with signature of guardian.