Exercise for Life

  • Exercise 4 Life(EX4L) Application

  • Exercise for Life (EX4L) is a strength and conditioning program for individuals ages 16 and up with a physical disability. The class provides an opportunity to work on building strength, endurance and flexibility in a group setting. The class is run by an exercise specialist under the supervision of a physical therapist. This is an excellent opportunity for participants to learn or build upon fitness skills and become more comfortable working out in a gym setting. Modifications will be made for each individual to promote independence and success. The program is offered in eight week sessions four times per year. The class is offered on Tuesday evenings and Saturday mornings. 

    2026 Sessions:

    Winter: Jan 20 - March 14

    Spring: April 7 - May 30

    Summer: July 28 - September 19

    Fall: October 20 - December 19

    Classes are located at Gaylord Physical Therapy in Cheshire

  • I would like to register for the Exercise for Life Program.*
  • Please indicate the class times you are available for (select all that apply). You will be registered for one time slot that you are available for based on class capacity. We will notify you of the date and time prior to the start of the class series*

  • Participant Information

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • What is your gender?*
  • Are you a Veteran?*

  • Sports Association Membership

  • Have you participated in a Gaylord Sports Association Program in the past?*

  • If you are not a member of the Sports Association, or have not participated in a program in the last 2 years, please also complete a member profile as part of your registration.  Click here for the link to the profile.  Once you have finished the member profile, return to this form, complete, and submit. 

  • Program Registration

  • Have you participated in the EX4L program in the past?*
  • Are you currently participating in a fitness routine?*
  • I currently participate in the following fitness routine(check all that apply):*
  • I currently exercise:*
  • What types of equipment have you used?(check all that apply)*
  • Are you cleared by a Doctor to participate in a fitness program?*
  • Are you able to get a Doctor's note if needed to participate in this program?*

  • Medical Information

  • What is your primary diagnosis?*
  • I currently use the following mobility aid(s)(click all that apply):*
  • How did you hear about this program?*

  • Acknowledgment

  • By submitting this form, I verify that the above information is current and accurate.  I understand that the above information will be kept confidential.  In order to provide a safe and fun experience your information may be shared with:  (1) Sports Association staff, coaches or instructors (2) other adaptive sports programs who will be working with you (3) medical professionals in case of emergency (4) as required for Sports Association grant reports.  I understand that it is my responsibility to inform the Sports Association regarding changes to my: (1) contact  information such as address, phone and email; (2) medical status including new diagnosis, surgery or medical changes; (3) any other information that is relevant to the safety of myself or others regarding my participation in Sports Association programs. 

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