Physical Activity Readiness Questionnaire (PAR Q)

Please complete this registration and medical questionnaire, before participating in our classes

Medical Questionnaire

First Name

Last Name

Date of Birth

Email Address

Phone

Have you been hospitalized in the last 12 months?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

If you answered YES to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time, and participate in boxing and Muay Thai in your current state of health.

Today's Date

I declare that the info I’ve provided is accurate & complete. I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.

Thanks for submitting!See you soon.Brian and the Combat Gym team 