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JGF Athlete Waiver

Physical Activity Readiness Questionnaire

Have you ever had any form of heart disease?
Do you have high blood pressure?
Do you have diabetes?
Do you have an abnormal resting EKG?
Have you ever experienced shortness of breath or chest pain?
Has a doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?
Do you often feel faint or have spells of diziness?
Do you have high cholesterol?
Do you have a family history of heart disease?
Are you active?
Do you currently smoke or have you smoked in the past?
Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?
Are you over age 65 and not accustomed to vigorous exercise?
I have read and answered the "Physical Activity Readiness Questionnaire." I understand that if I answered yes to any question, vigorous exercise or exercise testing should be postponed. Medical clearance may be necessary.

Additional Health History

Are you currently taking any medication?
Do you have any allergies?
Do you have any problems in following areas? Select all that apply.
Are you currently under the care of a health professional?

Just Get Fit Media Release

Waiver of Liability and release

Thanks for submitting!

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