SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER ____________________________________________________________________
Copyright © 2020 PAR-Q+ Collaboration
For more information, please contact
1. Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, and Gledhill N. Enhancing the eectiveness of clearance for physical activity participation; background and overall process. APNM 36(S1):S3-S13, 2011.
2. Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ. Evidence-based risk assessment and recommendations for physical activity clearance; Consensus Document. APNM
3. Chisholm DM, Collis ML, Kulak LL, Davenport W, and Gruber N. Physical activity readiness. British Columbia Medical Journal. 1975;17:375-378.
4. Thomas S, Reading J, and Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Canadian Journal of Sport Science 1992;17:4 338-345.
Citation for PAR-Q+
Warburton DER, Jamnik VK, Bredin SSD, and Gledhill N on behalf of the PAR-Q+ Collaboration.
The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity
Readiness Medical Examination (ePARmed-X+). Health & Fitness Journal of Canada 4(2):3-23, 2011.
If you answered NO to all of the FOLLOW-UP questions (pgs. 2-3) about your medical condition,
you are ready to become more physically active - sign the PARTICIPANT DECLARATION below:
If you answered YES to one or more of the follow-up questions about your medical condition:
You should seek further information before becoming more physically active or engaging in a tness appraisal. You should complete
the specially designed online screening and exercise recommendations program - the ePARmed-X+ at www.eparmedx.com
visit a qualied exercise professional to work through the ePARmed-X+ and for further information.
It is advised that you consult a qualied exercise professional to help you develop a safe and eective physical
activity plan to meet your health needs.
You are encouraged to start slowly and build up gradually - 20 to 60 minutes of low to moderate intensity exercise,
3-5 days per week including aerobic and muscle strengthening exercises.
As you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical activity per week.
If you are over the age of 45 yr and NOT
accustomed to regular vigorous to maximal eort exercise, consult a
qualied exercise professional before engaging in this intensity of exercise.
All persons who have completed the PAR-Q+ please read and sign the declaration below.
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.
Delay becoming more active if:
You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant - talk to your health care practitioner, your physician, a qualied exercise professional,
and/or complete the ePARmed-X+ at www.eparmedx.com
before becoming more physically active.
Your health changes - talk to your doctor or qualied exercise professional before continuing with any physical
You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO changes are permitted.
The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who
undertake physical activity and/or make use of the PAR-Q+ or ePARmed-X+. If in doubt after completing the questionnaire,
consult your doctor prior to physical activity.
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/tness center may retain a copy of this
form for records. In these instances, it will maintain the condentiality of the same, complying with applicable law.
The PAR-Q+ was created using the evidence-based AGREE process (1) by the PAR-Q+
Collaboration chaired by Dr. Darren E. R. Warburton with Dr. Norman Gledhill, Dr. Veronica
Jamnik, and Dr. Donald C. McKenzie (2). Production of this document has been made possible
through nancial contributions from the Public Health Agency of Canada and the BC Ministry
of Health Services. The views expressed herein do not necessarily represent the views of the
Public Health Agency of Canada or the BC Ministry of Health Services.