Registration

Name *

First Name

Last Name

Participant Waiver *

By checking the box below, you understand the following: Thank you for participating in the classes offered by Basecamp Prevention + Wellness, part of the Providence Heart Institute of Oregon. By participating, you understand that these classes may include exercises that may increase your heart rate and may increase your blood pressure. Your choice to participate certifies that you have no known ailment, disease, or organic condition, which would make your participation in these classes dangerous to your health. Please stop participation in these classes if any changes in your health or physical condition affects your ability to exercise (pregnancy, injury, illness, etc.). Your participation acknowledges that you have consulted with or had the opportunity to consult with your physician concerning your participation in these classes.

I understand.