SPIRIT Club Class Registration Spring 2024
I want to register for the weekly Spirit Club exercise group classes hosted by an MS Canada volunteer. Once registered you will be emailed a Zoom link that will be used to access the session each week on Tuesday morning, you can choose to
drop in
when you want and attend the classes that are of interest to you. You will also receive the link to make an account with SPIRIT Club to access
all of
their online content on your own if you want.
Sign up for online content only
.
This registration form below MUST be filled out to receive the MS Canada’s group membership link to create your free account with SPIRIT Club.
First Name
Last Name
Email Address
Phone number
Where do you live?
Please select...
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
How old are you?
Please select...
13 to 17
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
How do you identify your gender?
Please select...
Male
Female
Transexual
Transgender
Non-binary
Two-spirit
Not Listed
Prefer not to disclose
Please List:
Legal Guardian
This program is only available for those 14 and older, if you are under the age of 14 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 14 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.
I understand that this partnership program with SPIRIT Club is only available for those diagnosed with MS, an allied disease and their family caregiver.
If you do not have a diagnosis of MS, an allied disease or are their family caregiver you can pay for your own membership with SPIRIT Club by visiting their website
www.spiritclub.com
.
I understand and agree to the above
I do not agree
Which of the following best describes you
Please select...
I live with Clinically Isolated Syndrome
I live with Relapsing-remitting MS
I live with Primary Progressive MS
I live with Secondary Progressive MS
I live with an allied disease (e.g., NMOSD, TM, ADEM)
Unknown/not sure
I am a caregiver for a person who lives with MS or Allied disease (i.e. friend or family member)
Are you newly diagnosed?
Yes
No
Not 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 event:
Please select...
MS Canada website
MS Knowledge Network/MS Navigators
MS Canada staff/volunteer
MS Canada email/e-news
MS Canada social media pages
MS Canada event (MS Walk, peer support group, etc.)
MS Clinic/healthcare practitioner
Friend/acquaintance/family member
Other (specify)
Other
I understand that MS Canada is charged a fee for every account created with SPIRIT Club using MS Canada’s group membership (whether the account is used or not). If my SPIRIT Club account is inactive for 3 months, the account will be deleted. I will not share the SPIRIT Club partnership agreement link with anyone and understand that MS Canada is monitoring registration and account creation (anyone diagnosed with MS or an allied disease can register with MS Canada and receive the partnership link themselves). Anyone caught sharing the SPIRIT Club agreement link with others will be deleted and will no longer have access to SPIRIT Club through MS Canada’s membership account.
I understand and agree to the above
I do not agree
I understand that Spirit Club is an American company and
if I choose to access their online content
myself th
ey
will have my contact information and be able to contact me by email. The privacy laws in the States may be different from
Canada and I should do my own due diligence to ensure I understand what those
are
.
I understand and agree to the above
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 SPIRIT Club 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 SPIRIT Club.
I agree
Unfortunately, by selecting "I do not agree", you are unable to register. Please contact the Wellness team at
wellness@mscanada.ca
for further clarification or questions.
Contact Information