Login Username or Email Address Password Remember Me Type in the text displayed above Log In Lost your password? Register Membership Registration "*" indicates required fields Step 1 of 4 25% Email* 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.1) Has your doctor ever said that you have a heart condition OR high blood pressure?* Yes No Please select* Heart Condition High Blood Pressure 2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?* Yes No 3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?* Yes No 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)?* Yes No Please List Condition(s) Here:* Add Remove5) Are you currently taking prescribed medications for a chronic medical condition?* Yes No Please List Condition(s) and Medications Here:* Add Remove6) 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?* Yes No Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.Please List Condition(s) Here:* Add Remove7) Has your doctor ever said that you should only do medically supervised physical activity?* Yes No If you answered YES to one or more of the questions above, COMPLETE PAGES 2 AND 3. Delay becoming more active if: You are currently experiencing a temporary illness, such as a cold or fever. It is best to wait until you feel better. You are pregnant. In this case, talk your health care practitioner, physician, qualified exercise professional, and/or complete ePARmed-X+ at www.eparmedx.com before becoming more physically active. Your health changes. Answer the questionson page 2 and 3 of this document and/or talk to your health care practitioner, physician, qualified excercise professional before proceedingwith any physical activity program. If you answered NO to all of the questions above, you are cleared for physical activity. 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* MM slash DD slash YYYY Signature* RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTIONS OF RISK AND INDEMNITY AGREEMENT BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY! Assumption of Risks & Release of Liability, Waiver of claims and Indemnity I have completed the Pre-exercise screening form and have truthfully answered all questions to the best of my ability. I am aware that participation could, in some circumstances, result in physical injury and have discussed my participation, where applicable, with my physician. In consideration of the acceptance of participation in the program offered by Rise Yoga Canada for myself, my heirs, executors, administrators and assigns, waive any claims to which I may become entitled for injury or damage and WAIVE ANY AND ALL CLAIMS that I have or may in the future against Rise Yoga Canada and its directors, officers, employees, agents and representatives. TO RELEASE Rise Yoga Canada. From any and all liability for any loss, damage, injury or expense that I may suffer as a result of participating in the exercise programs offered by Christine Yankee due to any cause whatsoever. INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT ON THE PART OF Rise Yoga Canada.Confirmation of Agreement* I HAVE READ THIS AGREEMENT AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST RISE YOGA CANADA.NameThis field is for validation purposes and should be left unchanged. Order Tracking To track your order please enter your Order ID in the box below and press the "Track" button. This was given to you on your receipt and in the confirmation email you should have received. Order ID Billing email Track
