Par-q (Physical Activity Readiness Questionnaire) * First Name Last Name Telephone number Email Checkbox Do you suffer from any of the following: High Blood pressure Low Blood pressure Diabetes raised cholesterol heart condition that you are aware of ever felt pain in your chest when exercising ever suffered from shortness of breath is there a history of coronary heart disease in your family do you often feel faint, have spells of dizziness or have you ever lost consciousness do you drink more than the average amount of alcohol do you suffer from regular headaches are you pregnant is there any reason you know of which would stop you participating from activity is there any information you think your instructor should be aware of? Emergency Name and Number Further information you wish to provide to your instructor: If you answered yes to one or more of the above you should consult your doctor before engaging in this activity. If you answered no to more than one of the above it is safe for you to proceed with the activity with your current state of health. Please be aware that if the instructor thinks you are at risk they are entitled to stop participation. I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise/adventure, and my participation involves a risk of injury. Having answered yes to one of the questions above, I have sought medical advice and my GP has agreed I may exercise. Please sign below. Date MM DD YYYY Informed consent Adventure wellness includes but is not limited to paddle boarding, open water swimming, wild swimming, hiking, and fitness/exercise. The program is designed to improve fitness, strength, endurance, and boost well-being. Programs may include physical activities such as running, stretching, cardio classes with equipment, paddle boarding, swimming and walking. Each part of the program will be explained to you but please ask any questions if you are unclear. Notify the instructor should you not want to partake in any part of the program. All activities may contain certain risks such as muscle strains, joint sprains, aches, pains and general discomfort if you are not used to exercising. The program is designed to minimise the risk, however if at any point you feel in pain, discomfort or unwell you must stop and inform the instructor immediately. I confirm that I have read, understood and answered all the questions on the Par-Q accurately and to the best of my knowledge. I confirm that I wish to participate in this program and realise that the activities involve an element of risk of injury or even death. Please sign. yes no Thank you!