MOVE Registration: In-Person

MOVE by GoodLife Kids In-Person Program Registration

WELCOME! PLEASE USE THE FORM BELOW TO APPLY TO REGISTER FOR MOVE.

Thank you so much for your interest in joining the MOVE by GoodLife Kids In-Person Program.

MOVE by GoodLife Kids is a free physical activity and fitness program for youth 12 to 21 years with autism and intellectual disabilities.

Each MOVE by GoodLife Kids In-Person class is led by two MOVE Coaches. MOVE Coaches are fitness professionals who are trained in providing successful physical activity and fitness programming for individuals with autism and intellectual disabilities.

Please note that filling out this form does not guarantee the Participant to be registered in a MOVE Class. There are limited spots in each Class, and we are working hard to bring more locations across Canada!

Class Name*

Applicant Name*

First Last

A parent or guardian is required to fill out this form for anyone under the age of 18.*

I am a parent/guardian/caregiver

I am a participant aged 18 or over

How did you hear about MOVE?*

From the GoodLife Kids Foundation

From GoodLife Fitness

From another organization

From a friend/word of mouth

From an internet search

From social media

Other

How did you hear about MOVE from the GoodLife Kids Foundation?

Directly From an Associate/Staff Member

Directly from another Member/Participant

An email from GoodLife Kids Foundation

A social media post by GoodLife Kids (ad or post on their channel)

A social media post from someone else (posted in a group etc…)

Other

How did you hear about MOVE from GoodLife Fitness?

Directly From an Associate/Staff Member

Directly from another Member/Participant

An email from GoodLife Fitness

A social media post by GoodLife Fitness (ad or post on their channel)

A social media post from someone else (posted in a group etc…)

Other

Which social media platform did you hear about MOVE on?

We're so glad word is getting around! Please let us know who you heard about us from.

We would appreciate a little more detail to help us reach more Participants:

Please note that a caregiver is required to be present for each MOVE class. Before proceeding with the rest of the application please confirm that a caregiver can be present.*

Yes

No

Your Email*

CAREGIVER INFORMATION

Primary Caregiver Name*

First Last

Relationship to Participant*

Primary Caregiver Phone Number*

Primary Caregiver Email Address*

The email listed above will be used for all MOVE Program communication.

Will the primary caregiver listed above be the caregiver who will be attending the MOVE classes?*

Yes

No

Please provide the full name, email address, and phone number for the caregiver(s) who will attend the MOVE class.*

EMERGENCY CONTACT

Please provide the NAME and PHONE NUMBER of someone not attending the MOVE program that we can contact should we need to get ahold of them for any reason.

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Additional Emergency Contact Names & Phone Numbers

PARTICIPANT PROFILE

How is the Participant currently incorporating physical activity into their life?*

List any regular activities like sports, walking, biking, etc.

What special interests do they have? Do they have any fears or specific dislikes?*

What motivates the Participant to continue to work through challenging situations?*

Eg. Praise, video games, a break, candy, time on special interests etc.

How does the Participant best communicate?*

E.g. full sentences, fragmented speech, gestures, etc.

Please describe the type of support the Participant requires for sports and fitness activities? Does it differ for in-person or over Zoom?*

Tell us more about the Participant.*

Let us know if there is anything else that will help ensure a supportive and engaging experience for this participant.

Our Program Specialist will reach out to you to discuss next steps by phone or by email. If by phone, please list times in the next week you would be available for a 5-minute phone call.*

Eg. Weekdays before 11am, all day Friday… etc.

MOVE WAIVERS

Consent*

MOVE by GoodLife Kids – WAIVER AND VIDEO/PHOTO RELEASE
(hereinafter referred to as the “Release Agreement”)

BY SIGNING THIS DOCUMENT, YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
PLEASE READ CAREFULLY!

By my or my child’s participation (collectively referred to as “participants”) in a MOVE by GoodLife Kids Program (“the Program”) hosted online via Zoom, I hereby acknowledge and agree with the following:

That fitness activities, exercise and participation in the Program may expose participants to risks and hazards, some of which are inherent in the very nature of the fitness activities and exercise itself, others which result from human error and negligence and, as a result of such risk I, acknowledge that as participants, I or my child may suffer serious personal injury (even death). I understand that the GoodLife Kids Foundation (“the Foundation”), GoodLife Fitness Centres Inc. (“GoodLife”), the organizers of the Program and their respective officers, directors, employees, independent contractors, agents, affiliated clubs, sponsors, and volunteers (collectively the “Releasees”) do not assume any responsibility whatsoever for my safety during my participation in the Program. I nevertheless freely and voluntarily assume all the aforesaid risks and hazards, and the possibility of personal injury, death, property damage or loss, resulting therefrom and, I assume all risks of injury to myself or others including any illness or medical condition and any NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE PROGRAM.

I agree on my child’s behalf, my own behalf, and on behalf of my personal representatives, heirs, estate trustees or assigns to: (a) waive any and all claims that I have or may have in the future against the Releasees and I release, indemnify and discharge Releasees from any and all claims or causes of action (known or unknown) which may arise out of participation in the Program, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE PROGRAM; and (b) to indemnify and save the Releasees harmless from any and all claims or causes of action (known or unknown) brought against the Releasees by any party arising out of mine or my child’s actions, including my negligence, while participating in the Program.

I acknowledge that I may submit photographs or videos of my or my child’s participation in the Program, and that the Foundation may take photographs or videos during the Program that my image, likeness, voice and/or performance may be captured in such photographs and videos. I hereby unconditionally and irrevocably consent, authorize and grant to the Foundation, its successors, assigns and licensees, all necessary authority, right and license to use any photographs or videos (collectively “Photographs”) containing mine or my child’s image, throughout the world without limitations or restrictions and in their sole discretion, including without limitation: reproduction in all media, publication, display, exhibition for promotion, advertising, trade, art, or illustration. I confirm that the Foundation does and will forever own and retain all right, title and interest throughout the world in the Photographs, subject only to any assignment or license it may grant in its sole discretion. I hereby irrevocably and unconditionally assign to the Foundation and its licensees, successors and assigns all right, title and interest (including privacy, personality, moral and publicity rights) I have or may acquire in my image, likeness, voice and performance as contained in the Photographs and waive in favour of the Foundation and its licensees, successors and assigns all non-transferable rights and interests in the Photographs.

I HEREBY RELEASE THE RELEASEES from any and all claims which I may now or in the future have relating to the ownership, reproduction, display, distribution or other use of the Photographs and will hold them harmless in relation to complaints, actions, causes of action, liabilities, damages, losses, legal fees, costs and expenses of any nature and kind whatsoever incurred by any of them by reason of any claim relating to any damage whatsoever in respect of any act or omission in respect of the Photographs or any exploitation of the Photographs or this Agreement. I also acknowledge that all Programs offered by a MOVE Coach online may be recorded and saved for quality and training purposes. I understand that recordings will be stored securely by the Foundation for a minimum period of one (1) year. I hereby waive my rights to privacy and compensation, which I may have in connection with such use of my or my child’s name and likeness, including rights to any written copy that may be created in connection with video production, editing and promotion therewith.

If I am the parent or guardian of a minor participant (“the Minor”), I am hereby providing my express consent to the Foundation and GoodLife to allow the Minor to participate in the Program. By checking the box below, I am agreeing to the terms and conditions of this Release Agreement on my own behalf and/or on behalf of the Minor, as their parent or guardian. I acknowledge and agree that my heirs, executors, administrators and assigns will also be bound by this Release Agreement.

I have read the Waiver of Liability and Release Agreement above, and by clicking this box I do hereby consent to the terms and conditions listed herein.

Signature*

MOVE by GoodLife Kids In-Person Program Registration

WELCOME! PLEASE USE THE FORM BELOW TO APPLY TO REGISTER FOR MOVE.

PARTICIPANT PROFILE

CAREGIVER INFORMATION

EMERGENCY CONTACT

PARTICIPANT PROFILE

GENERAL PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

PARTICIPANT: PHYSICAL ACTIVITY READINESS

CAREGIVER: PHYSICAL ACTIVITY READINESS

PARTICIPANT DECLARATION

CAREGIVER DECLARATION

MOVE WAIVERS