EOPD Ireland Waterford Exercise Class Registration Form

EOPD Ireland Waterford Exercise Class Registration Form

Early Onset Parkinson's Disease Ireland, in partnership with Motiv8 Fitness, is delighted to offer evidence-based exercise classes specifically designed for people living with Early Onset Parkinson's disease. People with Parkinson's of all ages are welcome. These classes are suitable for a range of fitness levels and are led by qualified fitness professionals in a safe, supportive and welcoming environment.
Training takes place at Motiv8 Fitness in Waterford City ( Unit 38, Newtown, Waterford, X91 XA9W)

All sessions are 60 minutes in duration.

Classes will take place on Tuesdays 1030am-11:30am & Thursdays 2:30pm-3:30pm on the following dates:
- Week 1: 1 & 3 September
- Week 2: 8 & 10 September
- Week 3: 15 & 17 September
- Week 4: 22 & 24 September
- Week 5: 29 September & 1 October
- Week 6: 6 & 8 October
- Week 7: 13 & 15 October
- Week 8: 20 & 22 October
- Week 9: 27 & 29 October
- Week 10: 3 & 5 November
- Week 11: 10 & 12 November
Participant Details
Full Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityCountyEircode
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship to You
Emergency Contact Phone Number

Area CodePhone Number
Parkinson's Information
Have you been diagnosed with Parkinson's disease?
Do you currently experience any of the following?

Other
Health Screening
Has your GP or healthcare professional advised you not to exercise?
Do you have any medical conditions or injuries we should be aware of?
Are you currently pregnant?
Do you require any additional support or reasonable accommodations to participate?
Communications and Consent
Would you like to receive updates from Early Onset Parkinson's Disease Ireland about future classes, events and supports?
Please confirm the following
Privacy Notice
Privacy Notice text
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I consent to being added to a WhatsApp group for updates on class times, schedule changes and cancellations.
Should be Empty:

EOPD Ireland Waterford Exercise Class Registration Form

Participant Details

Emergency Contact

Parkinson's Information

Health Screening

Communications and Consent