PAR-Q

/PAR-Q
PAR-Q 2018-06-14T00:08:58+00:00

Physical Activity Readiness Questionnaire – PAR-Q

Welcome to the UE’s PAR-Q form. Please complete and submit the form below.

Your Name (required)

Your Email (required)

Your Phone Number (required)

Your Age

Your Height

Your Gender Identity

Emergency contact name (required)

Emergency contact phone number (required)

Health History: PAR-Q:

Has your doctor ever said you have a heart condition, and that you should only do physical activity recommended by a doctor?

YesNo

Do you feel pain in your chest when you do physical activity?
YesNo

In the past month, have you had chest pain when you were not doing physical activity?
YesNo

Do you lose balance because of dizziness or do you ever lose consciousness?
YesNo

Do you have a bone or joint problem (back, knee, or hip) that could be made worse by a change in your physical activity?
YesNo

Is your doctor prescribing drugs (for example water pills) for your blood pressure or heart condition?
YesNo

Do you know of any other reason why you should not participate in physical activity?
YesNo

Have you had surgery ever?
YesNo
If yes, what was the surgery?

Are you currently taking any medications regularly (aspirin, tylenol, birth control, etc.)?
YesNo

If yes, what medication?

Do you have any pain or stiffness in...:
BackKneesNeckShouldersHipsOther
Other:

Top 3 Goals:
Sport-Specific TrainingExplosivenessKnowledgeFoundationEnduranceFlexibilityIncrease StrengthReduce PainInjury PreventionOther
Other:

Any additional thoughts or comments?

Assumption of Risk
I am aware that participating in the event hosted by The Ultimate Experience Inc. exposes me to many inherent risks, dangers and hazards. By engaging in the event I freely accept and fully assume all inherent risks, dangers and hazards and possibility of personal injury, death, property damage or loss resulting there from. I agree to waive any and all claims that I have or may in the future have against the tourney organizers and their partners in the event due to any cause whatsoever including negligence.

Photograph and Media Consent and Release
I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify and hold harmless the producers from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I have read this document before signing below, and I fully understand the contents, meaning and impact of this consent, waiver, indemnity and release. This consent, waiver, indemnity and release is binding on me, my heirs, executors, administrators and assigns.

I further grant to the producers and their representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings in any media now known or later Developed. I acknowledge that The Ultimate Experience Inc owns all rights to the images and recordings.

I hereby grant permission to The Ultimate Experience and its representatives to take photographs or videos of me and to make recordings of my voice at the event or location I am 18 years of age or older and I am competent to contract in my own name, or if not, I have secured the signature of my parent or legal guardian.

Recent Tweets

Ultimate Experience disc on the grass

Get updates on the next Ultimate Experience!

Subscribe to our monthly newsletter.