Beruflich Dokumente
Kultur Dokumente
Name: ______________________________________
BMI: ___________
Recommendations by Teachers/Coaches:
Remarks:
Date:
To be Filled by Parents/Guardians: PAR-Q
As your child is to be a subject in this fitness test, would you please complete the following
physical activity readiness questions for your child.
Any information contained herein will be treated as confidential.
Please
Does your child have or has he/she ever experience any of the following? Circle
1. Has a doctor ever said that your child has a heart condition and that your Yes / No
child should only do physical activity recommended by doctors?
2. Does your child ever experience chest pain during physical activity Yes / No
3. Does your child ever lose balance because of dizziness or do they ever Yes / No
lose consciousness
4. Does your child have a bone or joint problem that could be made worse Yes / No
by a change in their physical activity participation?
6. Is your doctor currently prescribing any medication for your child’s blood Yes / No
pressure or a heart condition
9. Do you know of any other reason why your child should not undergo
physical activity? This might include, diabetes, a recent injury or serious Yes / No
illness.
Parent/Guardian’s Declaration
If you have answered NO to all questions then you can be reasonably sure that your child
can take part in the physical activity requirement of this fitness testing.
Pare Pare
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Please note: At any point of time, if your child’s health changes, notify the teachers and
consult with your doctor regarding the level of physical activity that your child can
participate in.
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Talk to your doctor in person discussing with him/her those questions you answered yes.
Ask your doctor if your child is able to participate in the physical activity requirements of
this fitness testing.