Par-Q Form

Pre-questionnaire for your teenager

First Name

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Birthday ( must be over 10 yrs of age to participate) * required

Next of Kin

Next of Kin Signature

Tell me about you * Required

Are you interverted (quiet

Are you an extravert (outgoing

Are you a determined person

Enjoys sports with teams

Like to exercise alone

Stiving to be a professional athlete

Looking forward to working with Sports Matrix to make personal changes

What are you wanting to learn from Sports Matrix? * Required

Nutritional advice - learn how to make better food choices

Exercise advice - Learn how to make better exercise choices

Sport specific training

To learn the skills to use food and exericse to help with a more positive mindset

To link with like minded people

To work together with your parents on food and exercise choices

All of the above

I accept terms & conditionsView terms of use

I confirm that the information given in this form is true

Your Signature

Date

Thanks for submitting!

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