TriForce Membership Registration- EN

Membership Registration
Amenez-moi au formulaire d'inscription français.

Name

First Name Last Name
Primary email
Are you a new member?
Phone Number

Area CodePhone Number
Birthday

MonthDayYear
Address

Street Address

Street Address Line 2

City Province

Postal code Country
Emergency Contact

First Name Last Name
Emergency Contact Phone Number

Area CodePhone Number
How did you hear about us?

Other
Who referred you?

Optimal health is our goal. Please read the questions carefully and answer each one honestly by checking YES or NO so that we can determine if our services are suitable for you and your goals at this period of time. Questions have been adapted from the CSEP Physical Activity Readiness- Questionnaire (PAR-Q) form.

Rows	YES	NO
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were NOT doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (ex: back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (ex: water pills) for your blood pressure or heart condition?
Do you know of ANY other reason why you should not do physical activity?

Please provide more details for the questions that you answered YES.
By answering YES to one or more questions, it is recommended that you seek physician approval BEFORE you start becoming more physically active with TriForce.
Please describe, if applicable, any other conditions (such as allergies, asthma), injuries (past and present), medications or surgeries that are not reported above.

My Products

12-month membership$240.00 CAD

6-month membership$160.00 CAD

3-month membership $100.00 CAD

1-month membership $50.00 CAD

Are you a NEW member? // Etes vous un NOUVEAU membre?$30.00 CAD

*one-time-fee for new members of TriForce AND the Tai Chi Centre
Item subtotal:

Total $0.00 CAD

Credit Card

Membership Start Date

MonthDayYear
Membership Expiry

MonthDayYear
Expiry Notification Date

MonthDayYear

As you know, physical activity is one of the best ways to improve overall health; however, being physically active has its own inherent risks. To keep things as safe as possible and running smoothly for everyone, check out our Membership Terms and Agreement.

By signing my name below I understand that this represents my legal signature and that it is legally binding.

J'ai déclare avoir lu et compris ce document et accepte mes droits et obligations tels que précisés. En entrant mon nom ci-dessous, je comprends que j'appose ma signature légale ayant force obligatoire.
Signature
Today's date

MonthDayYear
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