Gentle Yoga Registration Spring 2024

Gentle Yoga is an accessible way to move your body, connect with your breath and pay attention to how you’re feeling that day, moving within a comfortable range. For most of the class, participants will be seated in a chair, with the option given for a few standing poses if that works for you.  

The registration form below MUST be filled out to participate in the program. You will receive a Zoom link by email once you complete the registration, please save this link somewhere as you will use the same zoom link to access each class. Registration for this class is required and monitored, please do not share the zoom link with anyone for safety reasons. 

First Name:

Last Name:

Email Address:

Phone Number:

Where do you live?

Postal Code:

How old are you?

Legal Guardian Information

This program is only available for those 13 and older, if you are under the age of 13 please reach out to the wellness team to discuss other options: wellness@mscanada.ca or 1-800-268-7582.

If you are between the ages of 13 and 17 please have your legal guardian provide the following information:

Legal Guardian's First Name

Legal Guardian's Last Name

Legal Guardian's Email

Legal Guardian's Phone Number

Under 18 Consent

I am giving consent for the registrant, I understand and agree to the above.

*MS Canada reserves the right to contact the legal guardian to confirm consent.

How do you identify your gender?

Please List

Which of the following best describes you

Other

Are you newly diagnosed?

YesNoNot Applicable

How long have you been diagnosed ?

In the last year In the last 5 years More than 5 years

How did you hear about this program:

Other

Privacy Disclaimer: MS Canada protects your privacy in accordance with our privacy policy. The information provided in this survey will be entered into a database. The information will be used to provide you with the best services, to compile anonymous statistical information, and to communicate with you about MS Canada and its programs, events and volunteer opportunities. You can request at any time to be removed from our database. To acknowledge and consent to the collection and use by MS Canada of your personal information for these purposes, please click "I agree." If you have any questions about your personal information for the MS Canada's privacy policy and procedures, please contact our Privacy Office at priv@mscanada.ca or phone 1-800-268-7582.

I agree

Affirmation of Health:  

I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in the Program. I have been advised that an examination by a physician should be obtained by anyone prior to commencing the Program. If I have chosen not to obtain a physician's consent prior to beginning the Program, I hereby agree that I am doing so solely at my own risk.   

I agree

General Wellness Disclaimer:

I understand that the Program is intended to be a general wellness and recreational program. It is not intended as rehabilitation or physical therapy to correct a particular impairment or disability. The Program is not intended to be relied upon as therapeutic or as medical advice. I understand to consult my healthcare provider if I have any medical concerns.   

I agree

Waiver & Release Form:

I acknowledge that I have carefully read this "waiver and release form" and fully understand that it is a release of liability. I agree to release and discharge any trainer or instructor delivering the Program from any and all claims or causes of action and I agree to voluntarily waive any right that I may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage. In consideration for my voluntary participation in the Program, I, my heirs, executors, representatives, administrators, and assigns do hereby waive, release, and discharge MS Canada and instructor from any and all responsibilities, liabilities and lawsuits, present or future, and causes of action for ordinary negligence, whether foreseeable or unforeseeable, arising out of or related in any manner directly or indirectly, to my participation in the Program. 

I agree

Certification:

I certify that I have read this form and have had any questions answered to my satisfaction. By agreeing to this document/form, I am waiving certain rights I or my successors might have to bring a legal action or assert a claim against MS Canada and instructor.  

I agree