Activity Parq PDF Details

Activity Parq is an online platform for people with disabilities to find activities and events near them. The goal of the website is to make sure that all communities are able to participate in various types of activities, regardless of their abilities or disability status. The purpose of Activity Parq is three-fold: encourage participation in community events, promote awareness about disability rights, and provide information on available resources for people with disabilities. Activity Parq was founded by two women who were both born with physical disabilities but wanted to challenge themselves by pushing their limits. They wanted other disabled individuals around the world to have access to a safe place where they can go out into the world without fear of discrimination or harassment because of their disability status.

These are some details about activity parq. There, you'll obtain the specifics of the form you would like to fill out, along with the estimated time for yo

QuestionAnswer
Form NameActivity Parq
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesquestionnaire par q form, parq acsm, par q form, par q form download

Form Preview Example

2021 PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone

The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more physically active.

GENERAL HEALTH QUESTIONS

Please read the 7 questions below carefully and answer each one honestly: check YES or NO.

YES NO

1)Has your doctor ever said that you have a heart condition OOR high blood pressure O?

2)Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?

3)Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).

4)Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? please listcondition(S) here:

5)Are you currently taking prescribed medications for a chronic medical condition?

PLEASE LIST CONDITION(S) AND MEDICATIONS HERE:

6)Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically

active? Please answer NO if you had a problem in the past, but it doesnot limit your current ability to be physically active.

PLEASE LIST CONDITION(S) HERE:

o

o

7) Has your doctor ever said that you should only do medically supervised physical activity?

If you answered NO to all of the questions above, you are cleared for physical activity.

—I Please sign the PARTICIPANT DECLARATION. You do not need to complete Pages 2 and 3.

Start becoming much more physically active - start slowly and build up gradually.

Follow Global Physical Activity Guidelines for your age (https://www.who.int/publications/i/item/9789240015128).

You may take part in a health and fitness appraisal.

If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

►If you have any further questions, contact a qualified exercise professional.

PARTICIPANT DECLARATION

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.

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/fitness center may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

NAME

DATE

SIGNATURE _____________________________________

WITNESS

SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER

 

[i® If you answered YES to one or more of the questions above, COMPLETE PAGES 2 AND 3.

/*\ Delay becoming more active if:

You have a temporary illness such as a cold orfever; it is best to wait until you feel better.

You are pregnant - talk to your health care practitioner, your physician, a qualified exercise professional, and/or complete the ePARmed-XT at www.eparmedx.com before becoming more physically active.

Your health changes - answer the questions on Pages 2 and 3 of this document and/ortalkto your doctor ora qualified exercise professional before continuing with any physical activity program.

J

3

01-11-2020

2021 PAR-Qt

FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)

1.Do you have Arthritis, Osteoporosis, or Back Problems?

 

If the above condition(s) is/are present, answer questions la-lc

If noQ go to question 2

 

la.

Do you have difficulty control ling your condition with medications or other physician-prescribed therapies?

yesQ NOQ

 

(Answer NO if you are not currently taking medications or other treatments)

 

 

lb.

Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer,

YESQ NOQ

 

displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the

 

back of the spinal column)?

 

 

1c.

Have you had steroid injections or taken steroid tablets regularly for more than 3 months?

YESQ NOQ

2.Do you currently have Cancer of any kind?

 

If the above condition(s) is/are present, answer questions 2a-2b

If NO O go to question 3

 

2a.

Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of

yes[“) NO t-)

 

plasma cells), head, and/or neck?

 

u

2b.

Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?

YESQ NOQ

3.Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm

If the above condition(s) is/are present, answer questions 3a-3d

If NO

go to question 4

3a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)

3 b. Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction)

3c. Do you have chronic heart failure?

3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?

4.

Do you currently have High Blood Pressure?

 

 

If the above condition(s) is/are present, answer questions 4a-4b

If NO O 9° to question 5

4a.

Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?

 

(Answer NO if you are not currently taking medications or other treatments)

 

4b.

Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication?

 

(Answer YES if you do not know your resting blood pressure)

 

YESQ NOQ

yesQ NOQ

yesQ NOQ

YESQ NOQ

yesQ NOQ

YESQ NOQ

5.Do you have any Metabolic Conditions? This includes Type 1 Diabetes,Type 2 Diabetes, Pre-Diabetes

 

If the above condition(s) is/are present, answer questions 5a-5e

If NO [~] go to question 6

 

 

5a.

Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician-

YESQ

NOQ

 

prescribed therapies?

 

 

 

5 b.

Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or

 

 

 

during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability,

YESQ

NOQ

abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.

5c.

Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or

YESQ NOQ

 

complications affecting your eyes, kidneys, ORthe sensation in your toes and feet?

 

5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems)?

5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?

<- VI

NOQ

in □

 

YESQ NOQ

---------------------------------------------------------------------------------------------------------------------------------------------- Copyright© 2021 PAR-Q+Collaboration 2 / 4

01-11-2020

2021 PAR-Q+

6.Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer's, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome

 

If the above condition(s) is/are present, answer questions 6a-6b

If NO O go to question 7

 

6a.

Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?

yesQ NOQ

 

(Answer NO if you are not currently taking medications or other treatments)

 

 

6b.

Do you have Down Syndrome AND back problems affecting nerves or muscles?

 

yesQ NOQ

7.Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure

If the above condition(s) is/are present, answer questions 7a-7d

|f NO Q go to question 8

7a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)

7 b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?

7c. If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?

7d. Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?

8.Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia

If the above condition(s) is/are present, answer questions 8a-8c

If NO O go to question 9

8a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)

8 b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?

8c. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?

9.Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event

If the above condition(s) is/are present, answer questions 9a-9c

If NO Q go to question 10

9a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)

9 b. Do you have any impairment in walking or mobility?

9c. Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

YESQ noQ

yesQ noQ

yesQ NOQ

YESQ NoQ

yesQ NoQ

yesQ NOQ

yesQ noQ

yesQ NOQ

yesQ NOQ

YESQ NOQ

10.Do you have any other medical condition not listed above or do you have two or more medical conditions?

 

If you have other medical conditions, answer questions lOa-IOc

If NqQ read the Page 4 recommendations

10a.

Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12

YESQ

NOQ

 

months OR have you had a diagnosed concussion within the last 12 months?

 

 

 

10b.

Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?

YESQ

NoQ

10c.

Do you currently live with two or more medical conditions?

 

YESQ

NOQ

 

PLEASE LISTYOUR MEDICAL CONDITION(S)

 

 

 

 

AND ANY RELATED MEDICATIONS HERE:

 

 

 

GO to Page 4 for recommendations about your current medical condition(s) and sign the PARTICIPANT DECLARATION.

---------------------------------------------------------------------------------------------------------------------------------------------- Copyright© 2021 PAR-Q+Collaboration 3/ 4

01-11-2020

2021 PAR-Ql-

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 qualified 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 qualified exercise professional before continuing with any physical activity program.

•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.

PARTICIPANT DECLARATION

•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.

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/fitness center may retain a copy of this form for records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

NAME

SIGNATURE

SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER

----------- For more information, please contact

www.eparmedx.com

Email: eparmedx^gmailxom

Otttfcn for PAR-O+

Warburton DER, Jamnik VK, Bred in 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.

Key Referanees

DATE

WITNESS

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 financial 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.

1.Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, and Gledhill N. Enhancing the effectiveness of clearance for physical activity participation; background and overall process. APNM 36(S1):S3-S13, 2011.

2.Warburton DER, Gledhill N,JamnikVK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ. Evidence-based risk assessment and recommendations for physical activity clearance; Consensus Document. APNM 36(S1>:S266-s298,20l1.

3.Chisholm DM, Collis ML, Kulak LL, DavenportW, 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 Rea din ess Questionnaire (PAR-C&. Canadian Journal of Sport Science 1992;17:4 338-345.

---------------------------------------------------------------------------------------------------------------------------------------------- Copyright© 2021 PAR-Q+Collaboration 4/ 4

01 -11-2020

How to Edit Activity Parq Online for Free

Our PDF editor allows you to fill in documents. You should not undertake much to modify par q acsm forms. Only keep up with the following actions.

Step 1: The first task should be to click on the orange "Get Form Now" button.

Step 2: At this point, you're on the file editing page. You may add content, edit current details, highlight certain words or phrases, put crosses or checks, insert images, sign the form, erase unneeded fields, etc.

The next few areas are what you are going to fill out to get the finished PDF document.

entering details in questionnaire par q form step 1

You should enter the appropriate data in the I clearance is valid for a maximum, NAME, SIGNATURE, SIGNATURE OF PARENTGUARDIANCARE, DATE, WITNESS, i If you answered YES to one or, Delay becoming more active if, You have a temporary illness such, You are pregnant talk to your, Your health changes answer the, and Copyright PARQ Collaboration area.

Finishing questionnaire par q form stage 2

Indicate the vital particulars in Do you have Arthritis, If the above conditions isare, If noQ go to question, Do you have difficulty control, Do you have joint problems causing, Have you had steroid injections or, YESQ NOQ, Do you currently have Cancer of, If NO O go to question, a Does your cancer diagnosis, plasma cells head andor neck, b Are you currently receiving, YESQ NOQ, Do you have a Heart or, and go to question segment.

Filling out questionnaire par q form part 3

The Do you have an irregular heart, Do you have chronic heart failure, Do you have diagnosed coronary, Do you currently have High Blood, If NO O to question, yesQ NOQ, YESQ NOQ, Do you have difficulty controlling, yesQ NOQ, Do you have a resting blood, YESQ NOQ, Do you have any Metabolic, If the above conditions isare, If NO go to question, and Do you often have difficulty section will be the place to include the rights and responsibilities of each party.

questionnaire par q form Do you have an irregular heart, Do you have chronic heart failure, Do you have diagnosed coronary, Do you currently have High Blood, If NO O to question, yesQ NOQ, YESQ NOQ, Do you have difficulty controlling, yesQ NOQ, Do you have a resting blood, YESQ NOQ, Do you have any Metabolic, If the above conditions isare, If NO go to question, and Do you often have difficulty fields to insert

Complete the file by reviewing these areas: Are you planning to engage in what, YESQ NOQ, and Copyright PARQCollaboration.

Filling out questionnaire par q form step 5

Step 3: Choose the "Done" button. Now it's possible to export the PDF file to your device. Besides, it is possible to send it via electronic mail.

Step 4: Come up with as much as a few copies of the file to stay clear of all of the possible future concerns.

Watch Activity Parq Video Instruction

Activity Parq isn’t the one you’re looking for?

Related Documents

  • Acd 31075 Tax Registration Update

    "... State of New Mexico Taxation and Revenue Department Business Tax Registration Update Please type in black ink instructions for reverse new mexicotaxationand revenue department ident number nmtr ID 00 business number business address not po ..."

  • Ach Payment Enrollment Form

    "... This form can be used to enroll in automated clearinghouse ach payments for mom number 1510 0056. It contains an addendum record which includes payment-related information. ..."

  • Ach Stop Payment Form

    "... Stop payment for Mnet Spend Corp PO Box 2136 Austin, Texas 78768 2136 phone: 866 387-7363 fax: 512 532 88345 Date of request Customer Reference Number customer name Date of anticipated ach deduction Originating company ..."

  • Acs Income Based Repayment

    "... Please print this form clearly and make sure you use blue ink or black pen. You can also request an income-driven repayment plan. ..."

Please rate Activity Parq

2 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .