Registration Form
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Name *
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Session 1: January 8 - February 12, 2024

Harmony Creek Community Centre
15 Harmony Rd N, Bldg. B
Oshawa, ON
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PLEASE MAKE A NOTE OF THIS BEFORE SUBMITTING THE FORM!!

E-transfer payment to: Angela Woppman at: angela@afterburnworkouts.com
No Password Needed

Please include which class(s) you are registering for in the memo/notes section of the e-transfer.

PAR-Q QUESTIONS
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 (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
Do you know of any other reason why you should not do physical activity? *
If you answered YES to any of the above questions, please explain in detail here: *
It's important that you understand that any form of physical exercise can be strenuous and subject to risk of serious injury. You are urged to obtain a physical examination from a doctor before participating in any exercise activity, including those provided by Angela Woppman - CES, CPT. 

You agree that if you engage in any physical exercise or activity, you do so entirely at your own risk. 

This waiver and release of liability includes, without limitation, all injuries which may occur as a result of: (a) your participation in any activity or participation in any exercise routine and (b) instruction, training, supervision, or dietary recommendations by Angela Woppman - CES, CPT. 

You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. 

You expressly agree to release and discharge Angela Woppman - CES, CPT from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against Angela Woppman - CES, CPT for personal injury or property damage. 

By signing this release, you acknowledge and understand its content and that this release cannot be modified orally.
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I have read the above Waiver of Liability and agree to its terms: *
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As your coach, my goal is to help you reach ALL of your health and wellness goals which I will 100% guide you. 

Once I help you reach those goals, I ask that you help me reach my goal, which is to coach other clients like you to success! 

Once you've reached your goals, would you: 1) allow me to use you as a case study with your approval and 2) connect me with people you know who could use my help? Does this sound like good trade?
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I agree that all information provided on this form is accurate to the best of my knowledge: *
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Today's Date: *
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Type your full name here as your digital signature: *
Under 18yo? 

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