FITNESS TEST ASSESSMENT PREPARATION AND CONSENT FORM

STUDENT NAME and

SURNAME:
PARTICIPANT NAME
and SURNAME
DATE:

FITNESS TEST ASSESSMENT PREPARATION AND CONSENT FORM

PART A: PREPARATION
Please read through the following information carefully before you come for your fitness test:

 Confirm your fitness test appointment

 Do not exercise excessively 12 hours prior to the fitness test
 Do not smoke, drink alcohol, tea or coffee two hours prior to your test
 Do take all regular medication prescribed
 Dress in shorts, t/shirt & gym shoes OR flexible clothing that will allow the Trainer access to
e.g. a skinfold measurement on your thigh or upper back
 The fitness test is conducted indoors and outdoors
 The fitness test takes approximately 45 minutes

The fitness test includes the following:

 Resting heart rate
 Body composition assessment
 Blood pressure assessment
 Cardio-respiratory assessment
 Muscle strength & endurance assessment
 Flexibility assessment

PART B: CONSENT
The most physically demanding tests are those of the cardio-respiratory assessment. These tests
are designed to examine your heart rate response to sub-maximal exercise and recovery
periods. They consist of either:
1. Cycling on a specifically designed bicycle ergometer.
2. Stepping up on a bench for a specified duration.
3. Completing a 1.6km walk test.
4. Completing a 2.4km run test.

Complications have been rare during exercise tests, especially those of a sub-maximal nature. If
while you are exercising, and it becomes apparent that you are not tolerating the exercise well,
then the exercise is stopped. Mild light-headedness and even fainting may occur, but they are
NOT usual and disappear quickly on lying down. Other risks of injury while climbing onto or off
the cycle ergometer or the bench are possible, but rare.

In signing this Consent Form, you state that you have read and understood the description of the
assessments and their complications. Any questions you may have regarding these should be
raised with the Trainer prior to the fitness assessment. You enter into the fitness assessment
willingly and may withdraw at any time.

NAME and SURNAME OF PARTICIPANT:

SIGNATURE OF PARTICIPANT:

WITNESS:

DATE:
 WAIVER OF LIABILITY FORM

Liability release:

Recognising that participation in any physical activity includes the inherent possibility of both
external and internal injury and acknowledging that in his/her capacity as my Trainer/Coach
(Trainer/Coach’s full names) takes
every precaution to prevent the above.

I, (Participant’s full name) waive all legal claims

against (Trainer/Coach’s full name) for any injury of damage
that I might incur during or as a result of my participation in a training programme prescribed
by him/her.

NAME and SURNAME OF PARTICIPANT:

SIGNATURE OF PARTICIPANT:

WITNESS:

DATE:

PAR-Q (Physical Activity Readiness Questionnaire)

STUDENT NAME and
SURNAME:
 PARTICIPANT NAME and
SURNAME:
DATE:

PAR – Q & YOU

Physical Activity Readiness
Questionnaire - PAR-Q (revised 1994)
(A Questionnaire for People Aged 15 to 69)

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active
every day.
Being more active is very safe for most people. However, some people should check with their doctor before they
start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven
questions in the box below.
If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you
start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and
answer each one honestly: check YES or NO.

YES NO
  1. Has your doctor ever said that you have a heart condition and that you should only do physical activity
recommended by a doctor?
  2. Do you feel pain in your chest when you do physical activity?
  3. In the past month, have you had chest pain when you were not doing physical activity?
  4. Do you lose your balance because of dizziness or do you ever lose consciousness?
  5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
  6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart
condition?
  7. Do you know of any other reason why you should not do physical activity?

IF YOU ANSWERED YES to one or more questions

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you
have a fitness appraisal. Tell your doctor about the PAR-O and which questions you answered YES.
 You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to
restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to
participate in and follow his/her advice.
 Find out which community programs are safe and helpful for you.
 NO to all questions DELAY BECOMING MUCH MORE ACTIVE:

 If you are not feeling well because of temporary illness

If you answered NO honestly to all PAR-Q questions, you can be such as a cold or a fever – wait until you feel better; or
reasonably sure that you can:  If you are or may be pregnant – talk to your doctor
before you start becoming more active
 Start becoming much more physically active - begin slowly and
build up gradually. This is the safest and easiest way to go.

 Take part in a fitness appraisal - this is an excellent way to

determine your basic fitness so that you can plan the best way Please note: If your health changes so that you then
for you to live actively. It is also highly recommended that you answer YES to any of the above questions, tell your fitness
have your blood pressure evaluated. If your reading is over or health professional.
144/94, talk with your doctor before you start becoming much Ask whether you should change your physical activity plan.
more physically active.

Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for
persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.

No changes permitted. You are encouraged to copy the PAR-Q but only if you use the entire
form
© Canadian Society for Exercise Physiology Société. Canadienne de physiologie de l’exercice

Health Santé
Canada Canada

Note: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a
fitness appraisal, this section may be used for legal or administrative purposes.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

NAME: _______________________________________________________

SIGNATURE: __________________________________________________ DATE: __________________________________

SIGNATURE OF PARENT: ______________________________________ WITNESS: _______________________________
or GUARDIAN (for participants under the age of majority)

NOTE: This physical activity clearance is valid for a maximum of 12 months from the date it is
completed and becomes invalid if your condition changes so that you would answer YES to any of
the seven questions.