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Membership Form

Fill in the Physical Activity Readiness Questionnaire form below.

If under 18 to be completed by a parent/guardian.

Birthday
Gender
Male
Female
Prefer not to say
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No
Do you feel any pain in your chest when you do physical activity?
Yes
No
In the past month, have you had a chest pain when you were not doing physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint problem (for example back, kneed or hip) that could be made worse by a change in your physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Do you know of any other reason why you should not take place in physical activity?
Yes
No
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