Heart to Start Registration

Registration for Heart to Start!

Your answers below secure your spot for Season 14 and allow us to tailor the experience to you. Register for free today! Season 14 begins November 30th.
Each registration requires a unique email address. Everyone aged 18+ should complete their own registration.
Name*

First NameLast Name
Email*
example@example.com
City*

Street Address

Street Address Line 2

CityState

Zip Code
State*

Street Address

Street Address Line 2

CityState

Zip Code
How did you hear about us?*
Years participated in Heart to Start?*

This is my first one!1-45+
Do you live within 15 miles of Portland, Oregon?*

YesNo
How many children (under 18) are participating with you?*
What is your primary reason for participating?*
What is your preferred mode of movement?*
Language preference:*

EnglishSpanish
Are you a Providence employee?*

YesNo
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
What race(s) do you consider yourself to be?

Alaska NativeAmerican IndianAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhite/CaucasianSome other racePrefer not to sayUnknown
Do you consider yourself to be Hispanic or Latino?
How do you identify?

ManNon-binaryWomanPrefer to self-describe
PARTICIPANT WAIVER

Please read the information below and then check the box indicating your understanding.
By checking the box below, I wish to participate in the Providence Heart to Start program. I understand that my participation in an exercise program includes activities that may increase my heart rate and increase my blood pressure. I certify that I have no known ailment, disease, or organic condition which would make my participation in the Providence Heart to Start dangerous to my health. I have consulted with or had the opportunity to consult with my physician concerning my participation in this program. I understand that Providence Heart to Start invites participants to take part in or submit photos throughout the training season and goal event that will be shared to inspire others; I will not participate in or submit photos if I prefer they are not shared publicly.
Participant Waiver Acknowledgment*

I understand
If you have questions or comments regarding this registration or the upcoming Providence Heart to Start - Season 14, please send us an email.
Should be Empty:

Registration for Heart to Start!

PARTICIPANT WAIVER