Please read the 7 questions below carefully and answer each one honestly: check YES or NO.YESNO

OR high blood pressure? 1) Has your doctor ever said that you have a heart condition 2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity? 3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise

4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) in PAR-Q

5)Are you currently taking prescribed medications for a chronic medical condition? Please List condition in PAR-Q

6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.

7) Has your doctor ever said that you should only do medically supervised physical activity? If you answered NO to all of the questions above, you are cleared for physical activity. Please sign the PARTICIPANT DECLARATION. You do not need to complete Pages 2 and 3. Start becoming much more physically active - start slowly and build up gradually.

Follow Global Physical Activity Guidelines for your age. You may take part in a health and fitness appraisal. If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise. If you have any further questions, contact a qualified exercise professional.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form. I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/fitness center may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

If you answered YES to one or more of the questions above, fill the rest of PAR-Q.

1.Do you have Arthritis, Osteoporosis, or Back Problems? If the above condition(s) is/are present, answer questions 1a-1c Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the back of the spinal column)? Have you had steroid injections or taken steroid tablets regularly for more than 3 months?

2.Do you currently have Cancer of any kind? If the above condition(s) is/are present, answer questions 2a-2b Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and/or neck? Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?

Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm

3.If the above condition(s) is/are present, answer questions 3a-3d

Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction) Do you have chronic heart failure? Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?

4.Do you currently have High Blood Pressure?

If the above condition(s) is/are present, answer questions 4a-4b

Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? (Answer YES if you do not know your resting blood pressure)

5. If the above condition(s) is/are present, answer questions 5a-5e Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician- prescribed therapies? Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability,YES NO abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet? Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems)?

Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes

Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future? YESNO

6.Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer's, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome If the above condition(s) is/are present, answer questions 6a-6bgo to question 7 Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you have Down Syndrome AND back problems affecting nerves or muscles? Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure

If the above condition(s) is/are present, answer questions 7a-7d

Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy? If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week? Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?

Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia If NO If the above condition(s) is/are present, answer questions 8a-8c Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting? Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)? Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event If the above condition(s) is/are present, answer questions 9a-9c go to question 10 Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments) Do you have any impairment in walking or mobility? Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

Do you have any other medical condition not listed above or do you have two or more medical conditions?

If you have other medical conditions, answer questions 10a-10c Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 months OR have you had a diagnosed concussion within the last 12 months?

read the Page 4 recommendations

Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?YESNO 10c.Do you currently live with two or more medical conditions?