Portage and Wood County Extension, FoodWIse Virtual Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete this form to enroll.

I would like to enroll in a Virtual StrongBodies YES: *

Tuesdays and Thursdays @ 9AM

Those times don't work for me, please contact me with alternatives.

First Name *

Last Name *

Street Address *

City, State & Zip *

Age *

18--59

60+

If you participated in StrongBodies in the past, which location did you attend?

Email Address *

Confirm Email Address *

Phone Number *

How did you hear about this class?

Flyer

Facebook

A friend

Boys and Girls Club

Children's of Wiscosin

CAP Services

Case Worker

School

Other:

Clear selection

Are you in need of hand or ankle weights? (We have a limited number available to borrow.) *

Yes, I would like to be considered for hand and ankle weights

No, I have the equipment I need to particpant in the virutal StrongBodies program

Disclaimer: I have voluntarily enrolled in this virtual StrongBodies program of progressive exercise. The program is designed to place a gradually increased workload on the heart, lungs, muscles, and bones to help improve their function. I understand that participation in such a program may be associated with some risks. These risks may include but are not limited to: muscle soreness, fainting, disorders of heartbeat, abnormal blood pressure, and in very rare instances, heart attack. To the best of my knowledge, I do not have any limiting physical conditions or disabilities that would preclude an exercise program. I release everyone who has designed, promoted, or conducted the StrongBodies Program from all claims or liabilities whatsoever resulting from my participation in this program. I assume all risks and responsibility for any injury, damage, or any other adverse event that may result from my participation in this program. Before I begin this program, I have already been enrolled in the StrongBodies program in my local community and have abided by their respective registration requirements. I understand that each person may react differently to these fitness activities and these reactions cannot be predicted with complete accuracy. I will inform my Program Leader and/or my health care provider if I experience any unusual symptoms. *

I agree: By clicking I agree, I am indicating that I understand and accept the terms of the waiver listed above.

Clear form

Never submit passwords through Google Forms.

This form was created inside of UW-Madison Google Workspace. Report Abuse

Forms