Low-impact Exercise

lowLow-impact Exercise Sign Up

Get moving. Get Fit! Staying healthy requires a commitment to engaging in regular exercise. For seniors, we at RELC offer Low-Impact Exercise classes for men and women age 50 & up. This program is held weekly on Fridays at 9:00-10 a.m.

Participate. Call organizers Nicki Ayer at 402-660-5352.  Linda Anderson 402-305-5035.
phone

 

Sign up online.

In participating in this program you will be waiving and releasing all claims arising out of the Low Impact Exercise Class. In consideration of Resurrection Evangelical Lutheran Church providing the Low Impact Exercise Class and accepting me as a participant,

I , Agree as follows:

I am fully informed of the details of the Low Impact Exercise Class and have received satisfactory answers to all questions I have concerning this class. I do hereby assume the full risk of any injuries and all costs, damages, and losses that I may sustain as a result of participating in any and all activities connected with or associated with the class.

I assume all risks associated with my participation in the class and release, indemnify and hold harmless instructors Linda Anderson and Nicki Ayer and their respective directors, officers, employees, agents, successors, and assigns, from and against any and all claims, damages, liabilities, and expenses arising from my participation in the class. I have read and fully understand the foregoing terms.

Signature of Participant:

Date (xx/xx/xxxx) :


Registration Form

Class Location

Full Name

Birth Date:

Sex M/F:

Healthcare Provider:

Address:

City:

State:

Zip:

Home Phone:

Your Email

Emergency Contact:

Their Phone:

For most people, physical activity should not pose any problem or health hazard. This health history has been designed to identify the adults for whom physical activity might be inappropriate or for those who should have medical advice concerning the type of activity most suitable for them.

Please read the questions carefully and answer the question as it applies to you.

Has your doctor ever said you have heart disease (Y/N)? YesNo

Do you frequently have heart or chest pains (Y/N)? YesNo

Do you often feel faint or have spells of severe dizziness (Y/N)?YesNo

Has your doctor ever said your blood pressure was high (Y/N)? YesNo

Has your doctor ever told you that you have a bone or joint problem(s),
such as arthritis that has been aggravated by exercise, or might be
made worse with exercise? (Y/N)? YesNo

Are you over age 60 and not accustomed to vigorous exercise?(Y/N)? YesNo

Has your doctor ever told you that you have a bone or joint problem(s),
such as arthritis that has been aggravated by exercise, or might be
made worse with exercise? (Y/N)? YesNo

Do you suffer from any problems of the lower back, i.e., chronic pain,
or numbness? (Y/N)? YesNo

Are you currently taking any medications? (Y/N)? YesNo

If yes, please list:

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Print/Present Low-impact Exercise Forms (in PDF)

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