PAR-Q Which option are you filling the PAR-Q form for * In person Personal Training Online Personal Training Kettlebells Body Fit Collective How did you hear about 'CResults' * Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Emergency Name and Phone Number * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are you Recovering from and illness or surgery * Yes No Are you currently taking any medication * Yes No Have you been diagnosed with a heart condition or high blood pressure * Yes No Do you suffer from any lung conditions (asthma or bronchitis * Yes No Have you ever had a diagnosed orthopaedic condition * Yes No Do you feel pain your chest when you exercise * Yes No Do you feel dizzy or lightheaded during exercise * Yes No If answered yes to any of the above questions, please explain - Make sure you are okayed from your doctor before excessing * Yes Sign * Date of completion * MM DD YYYY Thank you!
