Cultivating the Heart Qualities

Cultivating the Heart Qualities
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Address*

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Are you a Providence employee?*

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Optional Demographic Information

Would you consider helping us continue to offer, improve, and enhance our free community classes and programs? This demographic information will help us improve our ability to serve our participants, enhance funding, and perform research around healthy lifestyle behaviors and our community-centered programming. All research data will be de-identified. We do not sell or give your information to third parties.
Would you mind answering our demographic questions?*

Happy to answer!No thanks.
Age
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PARTICIPANT WAIVER

Please read the information below and then check the box indicating your understanding.
By checking the box below, you understand the following: Thank you for participating in the classes offered by Basecamp Prevention + Wellness, part of the Providence Heart Institute of Oregon. By participating, you understand that these classes may include exercises that may increase your heart rate and may increase your blood pressure. Your choice to participate certifies that you have no known ailment, disease, or organic condition, which would make your participation in these classes dangerous to your health. Please stop participation in these classes if any changes in your health or physical condition affects your ability to exercise (pregnancy, injury, illness, etc.). Your participation acknowledges that you have consulted with or had the opportunity to consult with your physician concerning your participation in these classes.
Participant Waiver Acknowledgment*

I understand
If you have questions or comments regarding this registration or the upcoming Cultivating Heart Qualities, please send us an email.
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Cultivating the Heart Qualities

PARTICIPANT WAIVER