MOVE by GoodLife Kids In Person Program Caregiver Participation Form

Any caregivers who will be joining the workouts with MOVE Participant are required to complete the following form. Questions? Reach out at

Please complete this form in one sitting as the form will not save until you select “SUBMIT” on the last page. Google Chrome is the recommended web browser.
The following must be electronically signed by anyone participating in MOVE by GoodLife Kids Program
– Liability and photo/video release waiver
– Physical Activity Readiness Questions

You will receive a copy of the completed waivers immediately by email. If you do not receive it, please check your junk mail folder.

MOVE Participants Full Name(Required)
This helps connect your form to the correct participant.
MM slash DD slash YYYY
Your Full Name(Required)
Caregivers must be over the age of 18 years old to attend as a support for the MOVE Participant.
MM slash DD slash YYYY

Physical Activity and Readiness Questionnaire

Have you or the individual you are signing for had (within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem or other medical conditions that could be made worse by becoming more physically active?(Required)
Please answer NO if they had a problem in the past, but it does not limit their current ability to be physically active. Includes injuries or conditions related to heart, blood pressure, respiratory disease, back problems, or another condition.
Has your doctor ever said that they should only do medically supervised physical activity?(Required)

If you have answered yes to any of the above questions please consult a medical professional prior to beginning exercise.


[If you are less than the legal age required for consent or require the assistance of a care provider, your parent, guardian or care provider must also sign this form.]

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that GoodLife Kids Foundation may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Please enter your full name to confirm your electric signature.