PAR-

Q
Physical Activity Readiness Questionnaire
(A Questionnaire for PHYSED12 Students)

To achieve the health benefits of having regular or weekly exercises, we need

to gather some information from you to know the best and the most appropriate
exercise or movement to be administered during our Physical Education class.

Please read the questions carefully and answer each one honestly. Check YES or NO.
Do not forget to affix your e-signature at the end of the page.
A. Physical Health-related Questions YES NO

1. Do you feel any pain in your chest when you perform physical
activity?

2. Do you lose balance because of dizziness when performing

moderate physical activity?

3. Has your doctor declared that you have any medical condition?
If yes, state your medical condition. .

4. Did your doctor advise you not to do some physical activity?

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

6. Do you currently have a bone, joint, or soft tissue problem that

could be worse when you are more physically active?

6a. Do you have back problems?

6b. Do you have a recent fractured bone?

7. Are there other reasons which can impede you from doing any
physical activity?

8. Were you physically active before the pandemic happened?

 B. Health during the Pandemic Questions

1. How do you take care of yourself, especially during this time of the
pandemic?
- I don’t exercise much but I make sure for my body to move by doing
house chores and some activities by going out walking. Also, to eat at
right times with nutritious food mostly fish and vegetables due to my
mother’s influence and lots of water to stay hydrated. In terms of
mental health, I make sure to have time for myself to breathe, relax,
and rest.

2. Are you currently physically active?

- With the things I do in my day-to-day life, I cannot say that I am truly
physically active since I don’t have a clear routine for myself and I just
make sure that my body gets to move and stretched every day.

Name of the student: Princess Denere Esaga

Section: PSY 223
Height:5’4
Weight: 71
Age: 19

ACKNOWLEDGEMENT

This PAR-Q was given to me before doing any physical activity in Mr. Delos
Santos’s Physical Education class. All the information that I have provided here is
all facts which can help the Physical Education program be more beneficial and
more appropriate for me.

Princess Denere Esaga

Signature over printed name of the student

Maria Dallie Dizon

Signature over printed name of the parent/guardian