• be well Centers Fitness and Cooking Class Registration

    be well Centers Fitness and Cooking Class Registration

  • How would you prefer to be contacted?
  • Session 2 -March 5 through March 30 (May join at any time)
  • Session 3 -April 1 through April 29 (May join at any time)
  • Session 4 -May 1 through May 27 (May join at any time)

  • Additional Information

  • Birth Date
     - -
  • Gender
  • Ethnicity
  • Have you ever participated in any programming at your neighborhood recreation center (other than be well programming)?
  • If no, what prevented you from participating (check all that apply)?
  • What neighborhood do you live in?
  • How did you hear about the be well programs (check all that apply)?
  • What is your primary reason for using the be well center?

  • The next 2 questions ask about your MODERATE physical activity in the last month. MODERATE physical activity causes a slight increase in breathing and sweating at times. (These types of activities include: brisk walking, gardening and yard work, yoga).

  • The next 2 questions ask about your VIGOROUS physical activity in the last month. VIGOROUS physical activity causes heavy breathing and sweating a lot. (These types of activities include: running and jogging, aerobic activities such as zumba and step aerobics, bicycling).

  • How would you rate your health today? 10=excellent and 1=poor:
  • How confident are you that you can meet and maintain your healthy living goal?10=very confident and 1=not confident at all:

  • STAPLETON FOUNDATION BE WELL CENTERS –

    WAIVER OF LIABILITY AND RELEASE OF CLAIMS:

     

    Programs Offered Locations
    Physical Fitness Hiawatha Davis
    Healthy Eating Central Park
    Heart Health Screening MLK
    Wellness Moorhead
    Other Other

    In consideration of being permitted to participate in any program or activity offered by the Stapleton Foundation at facilities owned and operated by the City and County of Denver’s Department of Parks and Recreation (DPR), I do hereby, for myself, my family, and our heirs and administrators, waive any and all liability rights and release any and all claims we may have against the Stapleton Foundation and the City and County of Denver and their officials, employees, various sponsoring agencies, as well as paid and non-paid volunteers with respect to any damage, loss or injury resulting from or associated with such participation. Although I understand that a physician examination is not required for participation, it is highly advisable that I consult with a physician about my health before participating in athletic and strenuous activities. I have read this form and understand and consent to its content and knowingly request that I be allowed to participate in any programs offered by the Stapleton Foundation at DPR facilities in 2017.

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