Gold's Gym DC Metro Par-Q

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

Par-Q*

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
n the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Are you currently pregnant?
Do you have diabetes or thyroid condition?
Do you know of any other reason why you should not engage in physical activity?
Do you plan to become pregnant in the next 3 months?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?

If you answered Yes to any questions 1-8 above, A MEDICAL CLEARANCE FORM IS REQIRED of all participants prior to beginning training. If YES to any, physical and aerobic fitness activities CANNOT be administered. NOTE: Coaching staff reserve the right to require medical clearance from any client they feel may be at risk. Discuss with your personal doctor any connditions that may affect your exercise program. All precautions must be documented on the medical clearance form by your personal doctor.

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If you answered Yes to any questions 9 or 10, Gold's Gym requests written permission from your physician before you may participate in physical and aerobic fitness activities. If you choose not to get written permission, you must acknowledge by signing below that Gold's Gym has asked you to visit your physician to obtain medical release before beginning an exercise program. You have elected not to do so and assume the risk for any injuries arising from undertaking any and all exercise due to a known or unknown medical condition

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If you answered NO to all questions above, you have provided to Gold's Gym a general indication that you may participate in physical and aerobic fitness activities and/or fitness evaluation testing. The face that you answered NO to the above questions is no guarantee that you will have a normal response to exercise or that a fitness resimen will not cause you medical problems

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