PHYSICAL ACTIVITY READINESS QUESTIONNAIRE
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Increasing physical activity is safe for most people. However, some people should check with their doctor before they start an exercise program.
If you are planning to become much more physically active than you are now, start by answering the questions below. If you are between 18 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69, and you are not used to being very active, check with your doctor.
Please read the questions carefully and answer each one honestly. Choose Yes or No.
If you have answered Yes to one or more questions, the WellAware Center will contact your physician (contact information at the bottom of this form) for a release form after you sign up for membership.
PERSONAL HEALTH HISTORY
If you have answered Yes to two or more questions, the WellAware Center will contact your physician (contact information at the bottom of this form) for a release form after you sign up for membership. If you have answered No to all questions, continue with the fitness assessment to determine your basic fitness level (An exercise specialist will schedule this with you).
LIST OF MEDICATIONS
EMERGENCY CONTACT INFORMATION
This is my application for membership in the BJC WellAware Center. I understand that this application is subject to the review and approval of the Center. I am 18 or older. I must complete the Mandatory Fitness Assessment.