Physical Activity Readiness Questionnaire (PAR-Q)
Name: ________________________________________
Age: ____
Insert recent
photo here
Section: _________________
PHYSICAL FITNESS PRE-TEST SCORE CARD
PERSONAL PROFILE
Engaging in physical activity is healthy and enjoyable. For MOST people, doing vigorous to moderate physical activity is very safe.
However, for some people need to consult with their doctor before becoming physically active.
Since you will engage in physical activity for this physical education course, this questionnaire will tell you whether it is necessary
for you to seek further advice from a doctor before participating in class.
Name:_________________________
Age: _____
Section_________________________
Class Schedule: ___________
Sex:____
HEALTH RELATED COMPONENTS OF PHYSICAL FITNESS
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
2. Do you feel pain in your chest at rest during your daily activities of living, OR when you do
physical activity?
3. Do you lose balance because of dizziness OR have you lost consciousness in the last 12
months? Please answer NO if your dizziness was associated with over-breathing (including vigorous exercise).
4. Have you ever been diagnosed with another chronic medical condition (other than heart disease
or high blood pressure)? PLEASE LIST CONDITION(S) HERE: __________________________________________
5. Are you currently taking prescribed medications for a chronic medical condition? PLEASE LIST
CONDITION(S) AND MEDICATIONS HERE: __________________________________________
6. 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? Please answer NO if you had a problem in the past, but it does not limit our current ability to be physically
active.
PLEASE LIST CONDITION(S) HERE: __________________________________________
7. Do you know any other reason why you should not do physical activity? PLEASE LIST CONDITION(S)
CARDIOVASCULAR ENDURANCE TEST: 3-MINUTE STEP TEST (YMCA)
Heart Rate
Pulse Rate per minute
Before Exercise
After Exercise (Exercise Heart Rate)
After 3mins of Resting (Recovery Heart Rate)
Category: ________________
FLEXIBILITY
Attempt 1
Attempt 2
Attempt 3
Best Attempt
________(cm)
________(cm)
________(cm)
________(cm)
Category: ________________
HERE: __________________________________________
IF YOU answered YES to one or more questions
Talk with your PE instructor in person BEFORE you start becoming more
physically active and/or participating in Physical Education activities. Tell
your instructor about the PAR-Q and which questions you answered YES.
•
•
You may be able to do any physical activity you want-as long
as you start slowly and buildup gradually
For PE related activities, your instructor may give you alternate
physical activities which is safe for you OR may refer you to talk
to your doctor for advice regarding the physical activities that
are safe for you.
DELAY becoming much more active:
o
o
If you are not feeling well because of a temporary illness such
as cold or a fever – wait until you fell better
If you are or may be pregnant – talk with your doctor before you
start becoming more active. Convey this information to your PE
instructor by personally talking to them and presenting a
medical certificate.
IF YOU answered NO to all of the questions above, you are cleared for
physical activity.
You can start becoming more physically active.
You can participate in all of the physical activities set by the PE
course.
ü You can may take part in a health and fitness testing
ü Please sign the PARTICIPANT DECLARATION.
PARTICIPANT DECLARATION.
ü
ü
Push Up
No. of
Repetitions:
________
Category:
_______________
Curl Up
No. of
Repetitions:
________
Category:
_______________
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.
BODY COMPOSITION
BODY MASS INDEX:
_______________
Category:
______________
I, the undersigned, have read to my full satisfaction and completed this
questionnaire. I acknowledge that this physical activity clearance is valid
for the ___ semester, SY ____-_____ and becomes invalid if my condition
changes. I also acknowledge that the CMU Physical Education
Department may retain a copy of this form for its records. In these
instances, it will maintain the confidentiality of the same, complying with
the Data Privacy Act of 2012.
Height:
_______ (m)
Weight:
______ (kg)
HIP TO WAIST
RATIO:
____________
Category:
_______________
Hip Circumference:
___________ (cm)
Waist Circumference: __________ (cm)
Signature over Printed Name:
___________________________________________ Date: _______
PLEASE NOTE: If your health changes so that you then answer
YES to any of the above questions, tell your PE instructor. Ask
whether you should change your physical activity plan.
MUSCULAR ENDURANCE TEST
Signature over Printed Name of PARENT/GUARDIAN:
___________________________________________ Date: _______
Central Mindanao University- Physical Education Department 2024
Informed use of the PAR-Q. Adapted from: Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), 2022 PAR-Q+ collaboration and ACSM’s Health/Fitness Facility Standards and Guidelines,
1997 by American College of Sports Medicine
Evaluated by:
Checked by:
_________________________
__________________________
Name and Signature of Evaluator
Name and Signature of Instructor
MOVEMENT COMPETENCY SCREEN (PRE-TEST)
Name: ____________________________________ Section: ________________ Date:__________
Directions:
Student: Perform the following movement patterns without any assistance or external resistance. Using your
own body weight execute the following in sequence:
Movement Pattern
Squat
Lunge and Twist
Push-up
Bend and Pull
Repetitions
3 reps facing front, 3 reps facing right, 3 reps facing left
3 reps facing front, 3 reps facing right, 3 reps facing left
3 reps facing front, 3 reps facing right, 3 reps facing left
3 reps facing front, 3 reps facing right, 3 reps facing left
Each leg:
Single Leg Squat
3 reps facing front, 3 reps facing right, 3 reps facing left
Evaluator: Assess the performed movement pattern using the screening criteria below. Mark the observed
movement behavior with a check.
Movement Pattern
SQUAT
LUNGE AND
TWIST
PUSH UP
Screening Criteria
1. SHOULDERS: Held down away from the ears.
Elbows are held behind the ears throughout the
squat.
2. LUMBAR: Neutral throughout the squat
3. HIPS: Movement starts here, aligned and extension
obvious
4. ANKLES/FEET: Aligned with the knees and hips. In
contact with the ground, especially the heels at the
bottom of the squat and feet appear stable
5. HEAD: Centered
6. KNEES: Stable, aligned with the hips and feet
7. DEPTH: Thighs parallel with the ground
8. BALANCE: Maintained
1. SHOULDERS: held down and away from ears,
rotation occurs in the thoracic region of the spine
2. LUMBAR: Neutral position, does not hyperextend
during lunge, does not Flex laterally during the twist,
appears to be stable during rotation
3. HIPS- Horizontally aligned, accommodates stance
width with obvious mobility
4. ANKLES: Directly under the front knee and aligned
with the back knee
FOOT: Heel of lead leg in contact with the floor, trail
foot flexed and balanced on forefoot
5. HEAD: Centered
6. KNEES: Aligned with the shoulder, hip, and foot.
Front and back leg in a 90 degree position
7. DEPTH: Lead thigh parallel with the ground
8. BALANCE: Maintained
1. HEAD: Centered
2. SHOULDERS: Held down and away from the ears,
hands positioned directly underneath shoulders,
scapula in good position at the start, moving in a
rhythmic motion throughout the movement
3. LUMBAR: Neutral, does not extend or flex during
movement
4. DEPTH: Chest touched the floor
5. HIPS: aligned with the trunk and held stable
6. KNEES: Held stable
7. ANKLES/FEET: Aligned
8. BALANCE: Maintained
Check If
Observed
BEND AND PULL
Score
SINGLE LEG
SQUAT
1. SHOULDERS: Held down and away from the ears
when arms are extended overhead. Scapula remain
in a good start position as the hands drop below the
torso to begin the pull. Scapula moving in a balanced
and rhythmic motion during the pull with obvious
protraction and retraction.
2. LUMBAR: Neutral spine maintained during the bend.
No flexion during the bend or hyperextension during
the standing with arms overhead
3. DEPTH: Trunk parallel with the ground
4. HIPS: Bend is initiated here with no shifting left or
right with pelvis position maintained during the
movement
5. HEAD: Centered and moves with trunk
6. KNEES: Aligned and not hyperextended
7. ANKLES/FEET: Aligned
8. BALANCE: Maintained
1. DEPTH: Thigh parallel with the ground
2. LUMBAR: Neutral throughout the squat
3. HIPS: Movement starts here, aligned and extension
is obvious
4. ANKLES: Aligned with the knee and hip
FEET: In contact with the ground especially the heel
at the bottom of the squat and appears stable
5. HEAD: Centered
6. SHOULDERS: Held down away from the ears.
Elbows held behind the ears throughout the squat
7. KNEES: Stable, aligned with the hip and foot
8. BALANCE: Maintained for each leg
TOTAL
Adapted from: The Movement Competency Screen by Matthew Kritz (2012)
NOTE: PRIMARY Areas are indicated in bold letters, while SECONDARY Areas are indicated by gray colored
cells.
Condition
If 4 PRIMARY areas are marked; 4 SECONDARY areas are marked
If 3 PRIMARY areas are marked; 3 SECONDARY areas are marked
If 0-2 PRIMARY areas are marked; 0-2 SECONDARY areas are marked
Add all accumulated scores then rate the performance using the rating scale below:
EXCELLENT
26-30
NOTE: ENCIRLE rating.
GOOD
21-25
FAIR
16-20
SCORE
3
2
1
NEEDS IMPROVEMENT
10-15
Evaluated by:
Checked by:
_________________________
___________________________
Name and Signature of Evaluator
Name and Signature of Instructor