Sign-up form

The personal information that you provide when you register with Vitalize inc. is collected under the FOIP provincial Act. The personal information you provide will be used to process and facilitate you registration only. By filling out this form and sending it you will be securing a spot in the program. Please see Payment Methods below to find out how to pay for your program.

NameFirst and lastAgeWe won't tell

AddressInclude city, provice/state
Postal/Zip codeEmailAdd a valid address
Home Phone(403) 555-1234Mobile(403) 555-1234

Course Information

Class DescriptionDates

Physical Activity Readiness Questionnaire

If you are planning to become muchmore physically active than you are now, start by answering the seven questions below. If you are between 15 and 69, this will tell you if you should check with your doctor before you start. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.

YesNo	Has your doctor said that you have a heart condition and advised only medicallyapproved physical activity?
YesNo	Do you have chest pain brought on by physical activity?
YesNo	Have you developed chest pain at rest in the last month?
YesNo	Do you lose consciousness or lose your balance as a result of dizziness?
YesNo	Do you have a bone or joint problem that could be aggravated by a changein physical activity?
YesNo	Is you doctor currently prescribing medication for your blood pressure or aheart condition?
YesNo	Are you aware, through your own experience or a doctor’s advice, of any otherreason why you should not begin physical activity?

Consent

I have read and understood the above questionnaire and acknowledge that my participation in the Vitalize program is strictly voluntary. I agree that I alone am responsible for assessing whether my participation poses any problems or hazards to me. I understand that medical health information about me will be kept strictly confidential, except with my specific consent or in the case of an emergency. I undertake to inform my coach should there be any change in my medical condition because this may require changes to my exercise program to ensure continuing suitability. I understand and agree that Vitalize its officers or employees are not liable for any injury, illness, or death which may result from my participation in the coaching programs offered.

Fee Payment

Cheques are preferred, please include all post-dated cheques with your registration,payable to Vitalize Inc.
Post dated cheques made payable for the middle of each month.

3 Discovery Ridge Court SW
Calgary, AB T3H 4P8
Our Accepted Payments policy helps ensure that participants of Vitalize programs are offered safe, convenient payment options. We prefer payments made with cheques made out to Vitalize Inc on the first day of the program. We also take Visa and MasterCard payments; please bring Credit Cards with you to first day of programs.