CHIP Test Registration

You are about to register for the CHIP Test scheduled on: November 02, 2024

Test Fee: $115.00

Test Registration Fees Are Non Refundable

Not the date you're looking for? Go back to testing schedule

Personal Information: (All fields are required)

First Name

Last Name

Email Address

Date of Birth

Gender
Male Female

Cell Number

Text Alerts
Receive text alerts regarding my scheduled test

Driver's License Number

Driver's License State

Are you currently a sworn or certified police officer?
Yes No

Password

Confirm Password

Emergency Contact: (All fields are required)

First Name	Last Name
Phone	Relationship To You

Voluntary Compliance

Describe yourself in terms of One of the following groups:

Medical Information:

Payment Details: Test Fee: $115.00

Credit Card Number

Expiration Date

CVV What's this?

Name on Card

Address

City

State

Zip

Receive emails regarding upcoming tests

I agree to the Terms of Registration.
and that a Medical Approval Form must be signed and brought to the CHIP Test.
By opting to receive text alerts regarding your scheduled test, you also agree to the SMS Terms & Conditions.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? Yes No
Do you feel pain in your chest when you perform physical activity? Yes No
In the past month, have you had chest pain when you were not performing any physical activity? Yes No
Do you lose your balance because of dizziness, or do you ever lose consciousness? Yes No
Do you have a bone or joint problem that could be made worse by a change in your physical activity? Yes No
Is your doctor currently prescribing any medication for your blood pressure or a heart condition? Yes No
Do you know of any other reason why you should not engage in physical activity? Yes No
Given your response on the PAR-Q, it's advisable to consult with a medical professional before proceeding with registration or taking this test.