Section 1: Contact Details

Pool Location of your choice

If your class is available more than once per week, please select the day of your choice (as per Class Schedule)

First Name

Last Name

Day Phone

Evening Phone

Email:

Date

Address

City

Postal Code

How did you hear about us?

Occupation

Emergency Contact Person

Emergence Contact Phone No.

Section 2: Standard Health Questionnaire

What is your age ?

Have you participated in water fitness before?

yes no

If yes, where:

Have you been physically active during the last 6 months?

yes no

Describe your activity, duration, and frequency per week:

Do you have pain or injuries in any of the following areas:

neck upper back lower back

shoulder: right left

wrist: right left

hip: right left

knee: right left

ankle: right left

elbow: right left

Please list any other injuries here:

Are you taking any medication at the current time which would impact your ability to exercise?

yes no

If yes, please list medications and purpose:

What are your most important health and fitness goals?

to be regularly active improve flexibility tone/strengthen muscles

cardivascular fitness reduce stress lose inches

reduce pain gain weight rehabilitation

Is there anything else you would like to tell the instructor?

Are you comfortable exercising in deep water?

yes no

Equipment Note: We HIGHLY recommend the purchase of an aqua belt – so you are able to try all the exercises (shallow and deep). A pool noodle is also an option, but the belt provides much more stability and exercise intensity options! WaterWays Online Store...

VERY IMPORTANT! BEFORE YOU CONTINUE: Click here and download the Par-Q Fitness Assesment Form
(You MUST bring a completed and signed Par-Q Form with you to your first class. You CANNOT under any circumstances, attend class without this competed and signed form.)

I agree that The Waiver and all its terms and conditions are governed exclusively by the laws of the Province or Territory of Canada and I hereby irrevocably submit to the exclusive jurisdiction of the courts of that province or territory, and that I have had sufficient time to read and understand each item and all parts of The Waiver in its entirety and have agreed to the terms freely and voluntarily.  I understand that this waiver is binding on myself and my legal representatives.

I have completed this form accurately and have read, understood, and agree to both the The Waiver and the Terms and Conditions (please type I agree, or I disagree in the blank to the right)

Please note: Your registration is not yet complete, please proceed to the Section 2 for payment options and confirmation.