The following form is a pre-screen. .  A copy of the form below will be printed out, and you will sign the paper copy before your first session. 

Name *
Physical Activity Readiness Questionnaire (PAR-Q): Read the following 7 questions and check Yes or No. If you answer Yes to one or more questions, a medical clearance form from your physician will be required before you can participate in the Boot Camp sessions. 1) Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
2) Do you feel pain in your chest when you do physical activity? * *
3) In the past month, have you had chest pain when you were not doing physical activity?
4) Do you lose your balance because of dizziness or do you ever lose consciousness? *
5) Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
6) Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
7) Do you know of any other reason why you should not do physical activity? *
Please indicate with a check mark if you have experienced any of the following, please select "NONE" if none apply: *
Are you interested in a 30 minute one on one "success consultation" with Saara to discuss your barriers to a healthy life? We also spend this time figuring out how to get you on your best path to success ($70 value). Please indicate if you are interested below.