Name

Address

City

Province

Country

Postal Code

Home Phone

E-mail

Sport

Team

Level

Position

Shoots

Throws

Gender

  Select One Male Female

Age

Height

  Weight

 lbs

Program registered for

• Excel Fitness Inc. will administer a strength and conditioning program for the athlete named above.

• Once appointments are confirmed, a minimum of 24 hours is required to change or cancel. No show appointments are charged 100%

Physical Activity Readiness Questionnaire:
Please select appropriate answer.

Question 1

Do you or have you ever experienced chest pain, shortness of breath, pain in upper extremity as a result of physical activity?
Yes   No

Question 2

Have you ever been diagnosed with high blood pressure, heart

disease, risk factor for stroke or stress related conditions?
Yes   No

Question 3

Has your doctor ever advised you to not participate in any sports,

exercise program, or recreational activity as a result of the above conditions?
Yes   No

Question 4

Do you have any neuromuscular conditions that prevent you from participating in sports or exercise programs?
Yes No   

Question 5

Have you had any injuries or conditions, chronic or acute, that

currently prevent you from participating in sports or an exercise

program (ex. fractures, sprains, concussions)?
Yes   No

Question 6

Is there any other medical reason that does not allow you to participate in this or certain aspects of any exercise program or conditioning camp?
Yes   No

If yes, please advise