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SportMed Aboriginal RunWalk 2018 - Participant Application

Are you ready to make your personal commitment to becoming healthier and more active? As a SportMed Aboriginal RunWalk 2018 participant, you will train with your local community leader as part of the Aboriginal Healthy Living Activities 2018 initiative.

*Make sure you know the name of your group leader before you start filling out the form!

Gender *

Male

Female

Age *

How did you hear about the SportMed Aboriginal RunWalk program?

Friend/Family

Community Group

Honour Your Health Challenge

Partners Council

First Nations Health Authority

Work

My SportMed Aboriginal RunWalk Leader is (PICK ONE) *

Which Aboriginal RunWalk training program are you interested in participating in *

Nordic Walk 10K

Walk10K

LearnToRun10K

RunWalk10K

RunStronger10K

Which 10K Event are you registered for? *

Vancouver Sun Run (April 22, 2018)

Times Colonist 10K - Victoria (April 29, 2018)

Local Event on National Indigenous Peoples Day (June 21, 2018)

Local Event - Other

EXPERIENCE:

EXPERIENCE: I have been involved in previous Aboriginal RunWalk (ARW) and/or Honour Your Health Challenge (HYHC) program (check all that apply) *

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

I have never been involved in the ARW and/or HYHC program

What is your level of activity? *

Currently inactive

Currently active 2 to 3 days a week for a minimum of 20 minutes each time

Currently active more than 3 days a week for a minimum of 20 minutes each time

Are you currently pregnant? *

Yes

If YES, please complete the Physical Activity Readiness Questionnaire for Pregnancy (see below) and discuss with your doctor before starting on this exercise program. *Download the Physical Activity Readiness Questionnaire for Pregnancy

DISCLAIMER - Please read carefully *

*Read the Physical Activity Readiness Questionnaire (PAR-Q+)

AGREEMENT:

Read and check below *

I understand that running, training and my related participation in the SportMed Aboriginal RunWalk program has inherent risk, including risk of injury to me or my personal property.

I understand that video/photo may be taken by SportMedBC during clinics or events and my be used for editorial or promotional purposes.

I have read and accept the Physical Activity Readiness Questionnaire (PAR-Q)

In consideration for my participation in this program, I agree to hold SportMedBC and its employees and agents harmless and not liable for any damages, loss or injury to my person or property that may arise.

Please add your comments or questions here

Acknowledgement of the Registration Form (PLEASE TYPE YOUR FIRST AND LAST NAME) *

Date *

Leave this field blank