PAR-Q | The Wandering Tao

Name

Date

1. Has your doctor ever said that you have a heart condition OR that you should only do physical activity recommended by a medical professional?

Yes No

2. Do you feel pain or tightness in your chest when you perform physical activity?

Yes No

3. In the past month, have you had chest pain when you were NOT doing physical activity?[

Yes No

4. Do you lose your balance because of dizziness, or have you lost consciousness in the past 12 months?

Yes No

5. Are you currently prescribed medication for your blood pressure or a heart condition?

Yes No

6. Do you have a bone, joint, or spinal problem (e.g., severe arthritis, hip/knee replacement, chronic back pain) that could be worsened by gentle movement or balance transitions?

Yes No

7. Do you have an unmanaged or unstable chronic condition? (e.g., poorly controlled diabetes, severe respiratory issues, or unmanaged high/low blood pressure)

Yes No

8. Currently pregnant, or given birth in the last 6 months?

Yes No

9. Do you know of any other reason why you should not participate in physical activity?

Yes No

10. If you answered 'Yes' to any of the above, please provide further details:

11. Context & Goals (Optional)

Is there anything else you would like your instructor to know? (e.g., recent surgeries, joint replacements, specific balance concerns, or fitness goals)

11. Context & Goals (Optional) Is there anything else you would like your instructor to know? (e.g., recent surgeries, joint replacements, specific balance concerns, or fitness goals)

Current Physical Condition

Are you currently taking any medications that may affect your ability to exercise?

Yes No

If yes, please list them:

Have you recently undergone surgery or been advised to limit your physical activity?

Yes No

If yes, please provide details:

Physical Activity Readiness

Do you have any injuries, disabilities, or mobility restrictions that may affect your ability to participate in training?

Yes No

If yes, please explain:

Do you require any special assistance or adaptations to participate safely?

Yes No

If yes, please provide details:

Declaration and Assumption of Risk

I confirm that the information provided above is accurate and complete to the best of my knowledge. I understand that martial arts training is physically demanding and carries inherent risks, including but not limited to injury, sprains, fractures, or other physical harm. I confirm that I have either consulted a healthcare professional regarding my ability to participate in physical activity or am voluntarily assuming responsibility for my participation. I agree to notify the instructor immediately if any medical conditions change that may impact my ability to train safely.

Welcome to Your Health & Movement Check!

11. Context & Goals (Optional)

Current Physical Condition

Physical Activity Readiness

Declaration and Assumption of Risk

Register your interest