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Registration request for Walk-Fit Class

Thank you for your interest in this event/program. Please complete and submit the form below.


Timeslot:
26 dates
Beginning Friday 1st Nov 2019, 9:30am - 10:45am
Ending Friday 15th May 2020
And including:
Friday 8th Nov 2019
Friday 15th Nov 2019
Friday 22nd Nov 2019
Friday 29th Nov 2019
Friday 6th Dec 2019
Friday 13th Dec 2019
Friday 3rd Jan 2020
Friday 10th Jan 2020
Friday 17th Jan 2020
Friday 24th Jan 2020
Friday 31st Jan 2020
Friday 7th Feb 2020
Friday 14th Feb 2020
Friday 21st Feb 2020
Friday 28th Feb 2020
Friday 6th Mar 2020
Friday 13th Mar 2020
Friday 20th Mar 2020
Friday 27th Mar 2020
Friday 3rd Apr 2020
Friday 17th Apr 2020
Friday 24th Apr 2020
Friday 1st May 2020
Friday 8th May 2020
Location:
Erin Indoor Rec Centre, 184 Main St. Erin ON Click here for map
Availability:
65 spaces remaining



Name:
 
Date of Birth:
Email:
Confirm email:
 
Phone Number:
 
Are you enrolled with one of our physicians?
How did you hear about this program?
Message:
 
Important:
I know that walking is a potentially hazardous activity. I should not enter a walking program if there is any known reason I should not be doing so.

I acknowledge the effects if indoor temperatures including air-conditioning, high heat, or that falls and contact with other participants are all risks being known and appreciated by me. In the case of inclement weather, it is my responsibility to check the East Wellington Family Health Team website at www.ewfht.ca or call the clinic at 519-833-9396 to see if the program is running.  Having read this waiver and knowing these facts, I for myself and anyone entitled to act on my behalf, waive and release the East Wellington Family Health Team, and all their leaders, staff, and volunteers from all claims or liabilities of any kind arising out of my participation in these activities even if that liability may arise out of negligence.

If you cannot click "yes", please do not continue with this online registration and call us directly at 519 833-7576, Ext 362.
Do you agree to the above statement? Yes

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