PHYSICAL READINESS QUESTIONNAIRE
Note: The required training and exercises within the Port Hedland MMA Association Training Courses consists of, but not limited to the following: Mixed Martial Arts techniques, etc. and participants are required to complete the questionnaire below as a prerequisite before starting the course for assessment of any special needs and/or considerations.
1. Has your doctor ever said you have a heart condition or vascular disease? Yes/No
2. Do you ever experience chest pains? Yes/No
3. Have you experienced any chest pain recently? Yes/No
4. Do you ever feel faint, dizzy, lose balance or lose consciousness? Yes/No
5. Has your doctor ever said you have high blood pressure (140/90)? Yes/No
6. Are you taking any medication for blood pressure or a heart condition? Yes/No
7. Are you a male over 35 or, a female over 45 and not accustomed to exercise? Yes/No
8. Do you have a bone or joint problem that could be made worse by a change in your physical activity? Yes/No
9. Do you suffer from asthma? Yes/No
10. Do you suffer from any other respiratory problems? Yes/No
11. Do you suffer from diabetes? Yes/No
12. Do you suffer from epilepsy? Yes/No
13. Do you currently suffer from any illness not mentioned here? Yes/No
14. Do you know of any other reason why you should not participate in physical activity? Yes/No
15. Do you suffer from any allergies? Yes/No
NOTE: If you have answered YES to any of the above questions, please provide more information in the medical conditions section directly below on this sign-up page.
You may also be required to provide a doctor’s certificate/clearance before you will be allowed to participate.
I declare to the best of my knowledge, I have answered the questions above truthfully. I understand and agree that it is my responsibility to inform Port Hedland MMA Association of any conditions or changes in my health, now and ongoing, which might affect my ability to participate safely in required exercises.