YMCA HIKING AND OUTDOOR CLUB

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE(PAR-Q)For most people, physical activity should not pose any problem or hazard. PAR-Q hasbeen designed to identify the small number of adults for whom physical activity mightbe inappropriate or those who should have medical advice concerning the type ofactivity most suitable for them.PLEASE ANSWER ALL THE QUESTIONSHas your doctor ever said you have heart trouble? _________Do you ever suffer from pains in your heart or chest? _________Do you ever feel faint or have dizzy spells? _________Has your doctor ever said your blood pressure was too high? _________Has your doctor ever told you that you have a bone or joint problem suchas arthritis which may be aggravated by exercise or made worse by exercise? _________Is there a good physical reason not mentioned here why youshould not follow an activity program even though you want to? _________OTHER INFORMATION (i.e. allergies, etc.)____________________________________________________________________________________________________________________________________________________Je confirme avoir demandé ce document en version anglaise, une version française étant aussi disponible. I confirm thatI have requested an English language version of this document, a French language version being available.Signature ____________________________Date ____________________________Renewal Of Club MembershipClub membership is renewable on May 1. Membership for Y members (any Downtown Ybranch in Montréal) is FREE, but you still have to fill out both sides of this form. The fees formembership for non-Y members are payable by cheque made out to THE YMCAs OFQUÉBEC in the amount of $33.86 ($30 + taxes).In either case, please fill out and sign both sides of this formand mail it together with your cheque of $33.86 (if applicable)to the address at right c/o Norma Cobetto or leave it at thefront desk of the Downtown Y Centre.THE YMCAs OF QUÉBECHiking and OutdoorClub1440 Stanley streetMontréal (Québec)H3A 1P7