Clinic Nordic Walking Class Registration 2023

Nordic WalkFit Registration 2023 – Public "Learn How to Nordic Walk" Clinics and Private Lessons

We organize public "Learn How to Nordic Walk" clinics at the start of every season with a maximum of 15 participants per class instructor/nordic walk leader. Upcoming dates and times listed below. All clinics are lead by a Certified Nordic Walking & Fitness Instructor with First Aid/CPR training!! Reap all the health benefits of exercising safely outdoors with qualified, experienced and knowledgeable leaders! Register today! Join us for Fun, Fitness, Friends and Fresh Air! www.nordicwalkfit.com 613-867-2744
Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Cell Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Emergency Contact Name*
Person we should contact in case of an emergency
Relationship to Participant*
Emergency Contact Phone Number*

Area CodePhone Number
Please select the clinic date you plan to attend. Pricing includes GST/HST.*

Saturday, April 15 10:30AM - Kanata Recreation Centre - "Learn How to Nordic Walk" Public Clinic $20/personMonday, April 17 1:30PM - Kanata Recreation Centre "Learn How to Nordic Walk" Public Clinic $20/personPrivate Lesson "Learn How to Nordic Walk" Proper technique instruction (improve posture, gait, balance & strength) Practical Lesson. (60-90 minutes) $65/person or couple. Group of 4: $25/person. Email nadine.imbleau@gmail.com to schedule date, time & location.
Payment by*

ChequeInterac Bank e-transfer
Please mail your cheque to Nordic WalkFit c/o Nadine Imbleau-Redman 542 Pennycross Lane Carp, ON K0A 1L0.
Please use your bank's online banking app or website to make your Interac E-transfer to nadine.imbleau@gmail.com (automatic deposit is set up to Nordic WalkFit account with this e-mail address).
- Please include in the notes area the name of the course and the name of the person registered, to help us connect payments to registrations.
For your safety and enjoyment, we require every participant to submit a Health Questionnaire (Par Q) upon registration to ensure you are registering for an appropriate fitness class level. Have you submitted an updated Health Questionnaire (Par Q) with Nordic WalkFit this year? If you are a new member with Nordic WalkFit, select No.*

YesNo
Health Questionnaire with Par Q

At least once per calendar year, each participant must submit an updated Health Questionannaire with Par Q below. Please inform Nordic WalkFit of your health status or of any changes to your health any time before, during or after registering for a class.

We also ask that each participant fill in an Emergency Contact Card and bring it to every class, so that it will be available in case of any emergency.

Click the link above to display a printable form for the card in a new browser window or tab.
Birth Date ?(DD/MM/YYYY).

0/20
Age (years)?.*

0/10
A/ Do you have any acute or chronic conditions that should be taken into account in determining the class most suitable for you? (please select any that apply)*

1. Asthma/ Lung Disease2. Diabetes3. Osteoporosis4. Rheumatoid Arthritis5. Osteoarthritis6. Frozen shoulder or tennis elbow7. Visual Limitation8. Pain in any area9. Balance, gait or coordination limitations10. Heart DiseaseNone of the above

Please provide additional health information if you answered YES to any of the questions in the Health Par Q.

0/200
Urban Poles are available at each class for borrowing if participants do not have their own poles.

Yes, I will need to borrow nordic walking/ urban poles (all poles will be sanitized prior and after use)
How did you learn about Nordic WalkFit?*
Comments or Questions for us?.

0/100
Thank You!

Your spot is "on reserve" upon pressing the REGISTER NOW button. Confirmation of your class and spot will be upon receipt of payment. We look forward to enjoying Fun, Fitness, Friends and Fresh Air with you! www.nordicwalkfit.com 613-867-2744
Should be Empty:

	Yes	No
1. Has your Doctor ever told you that you had a health problem? If yes, please provide additional information below.
2. Has your Doctor ever told you that you have high blood pressure?
3. Have you ever had a stroke or heart attack?
4. Have you ever had pain in your chest?
5. Do you ever feel faint or have dizzy spells?
6. Have you had surgery in the past 6 months?
7. Do you have any bone or joint problems?

Nordic WalkFit Registration 2023 – Public "Learn How to Nordic Walk" Clinics and Private Lessons

Health Questionnaire with Par Q

Thank You!