TriForce Master's L2 - Program Registration- EN

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Name*

First NameLast Name

E-mail

example@example.com

Are you new to TriForce?*

Yes, I'm new to the Master's FamilyNo, I'm a returning Master's WarriorNo, I'm a returning Master's Warrior but my info has changed

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact *

First NameLast Name

Emergency contact phone number*

Area CodePhone Number

Birthday*

Please read the questions carefully and answer each one honestly by checking YES or NO. Questions have been adapted from the CSEP Physical Activity Readiness- Questionnaire (PAR-Q) form.

	YES	NO
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were NOT doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (ex: back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (ex: water pills) for your blood pressure or heart condition?
Do you know of ANY other reason why you should not do physical activity?

Please provide more details for the questions that you answered YES to.

By answering YES to one or more questions, it is recommended that you seek physician approval BEFORE you start becoming more physically active with TriForce.

I will meet with my doctor and obtain his written approval BEFORE starting any program with TriForce.I will NOT meet with my doctor. I agree that my electronic signature below indicates my acceptance of all risks associated with commencing a physical activity regimen without first obtaining the recommended physician clearance.

Please describe, if applicable, any other conditions (such as allergies, asthma), injuries (past and present), medications or surgeries that are not reported above.*

Do you want to pay online or in person?*

Pay OnlinePay in-person

This winter session runs from Tues, Jan 10th until Friday, April 7th for a total of 39 classes. Which day(s) and how many classes on each day will you be joining us for this 13-week program?

Day 1: Total Body Strength - Tuesdays: Jan 10-April 4 @ 10am - 11am *

$7.50 each

Day 2: Total Body Strength - Thursdays: Jan 12-April 6 @ 9am-10am*

$7.50 each

Day 3: Conditioning & Mobility - Fridays: Jan 13-April 7 @ 9am - 10am*

$7.50 each

Online Maintenance Fee $3.50 CAD*

Total Cost

$

This winter session runs from Tues, Jan 10th until Friday, April 7th for a total of 39 classes. Which day(s) and how many classes on each day will you be joining us for this 13-week program?

Day 1: Total Body Strength - Tuesdays: Jan 10-April 4 @ 10am - 11am$7.50CAD

Quantity

Day 2: Total Body Strength - Thursdays: Jan 12-April 6 @ 9am-10am$7.50CAD

Quantity

Day 3: Conditioning & Mobility - Fridays: Jan 13-April 7 @ 9am - 10am$7.50CAD

Quantity

Online Maintenance Fee$3.50CAD

Total $0.00CAD

Credit Card

Signature

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(*After payment there will be no further adjustments to the price or issue of any refunds of any kind for missed classes. You may email an appeal for a "reasonable" extension for any "in-person cancellation" of classes that you paid for, in guidance with unforeseen/foreseen circumstances including weather. Your appeal must be sent within 1 week of the cancellation of that class in question or you forfeit your right for an appeal. All appeals will be reviewed on a case by case basis. There is no guarantee you will be granted an extension despite following the appeal process. Note: Reimbursements will not be offered as stated above, only extensions.)

Master's Level 2 - Program Registration

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