TriForce Membership Registration- EN

Amenez-moi au formulaire d'inscription français.

Name *

First Name Last Name

Primary email

Are you a new member?

Yes, I'm new to the TriForce Fam! No, I'm renewing to keep at my goals. No, I'm renewing my membership but my info has changed.

Phone Number *

Area Code Phone Number

Birthday *

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Address *

Street Address
Street Address Line 2
City	Province
Postal code	Country

Emergency Contact *

First Name Last Name

Emergency Contact Phone Number *

Area Code Phone Number

How did you hear about us? *

Walked by Website Social Media (Facebook, Instagram) Someone who goes to TriForce

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. *

	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. *

I will meet with my doctor and obtain his written approval BEFORE starting any program with TriForce. I will NOT meet with my doctor. I agree that my electronic signature below indicates my acceptance of all risks associated with commencing a physical activity regimen without first obtaining the recommended physician clearance. I will sign a liability and release waiver before my next TriForce activity.

Please describe, if applicable, any other conditions (such as allergies, asthma), injuries (past and present), medications or surgeries that are not reported above.

Which membership are you registering for? *

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? Free

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

Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Membership Start Date

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Membership Expiry

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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.

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