Functional Movement Class Sign-Up

Functional Movement is a monthly series. When you register, you’re signing up for all Tuesday OR Friday classes that month. We kindly ask that you attend all sessions in the month you register for.

Classes will take place at InspireHealth Vancouver, #240 – 575 West 10th Avenue.

If this month’s series are currently full, you’re welcome to join the waitlist below and we’ll be in touch if space opens up or for a future session.

To make room for new participants, priority will be given to those who haven’t taken the class before. If you’ve attended already and would like to join again, please add your name to the waitlist below.

"*" indicates required fields

Have you previously registered as a patient at InspireHealth?*

Have you previously taken a Functional Movement class at InspireHealth?*

Which InspireHealth Functional Movement Series are you registering for?*

Thanks for your interest in joining again! To help make space for new participants, we kindly ask returning participants to join the waitlist. We’ll be in touch if a spot opens up or for a future session.

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Contact Information

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

New Patient Information

Yes, I would like to register as a patient with InspireHealth to access free supportive cancer care programs and services.

Name*

First Last

Preferred name (if different from above)

Phone*

Mobile Phone

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City Province Postal Code

What is your gender?*

Patient Provincial Health/BC Care Card Number

Date of Birth*

Cancer diagnosis:*

Emergency Contact Information*

Full Name Relationship

Emergency Contact Phone*

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How did you hear about us?

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How did you hear about us?

Please specify who: (e.g. BC Cancer, Canadian Cancer Society (CCS), CCS Lodge, Doctor/Physician, Healthcare Professional, Family Member, Friend, Online Search, or Other).

How did you hear about us?*

Referred by a healthcare provider or cancer organization (eg. oncologist, surgeon, counsellor, Canadian Cancer Society, BC Cancer etc.)

Referred by a family member, friend, or colleague

Online search or website

Social media (ie. Facebook, Instagram, LinkedIn)

Print material (brochure, flyer, poster)

Event or presentation

Other (please specify)

Please specify*

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Join our Orientation Session to learn more about InspireHealth’s free programs and services.

Monday 3:00 - 3:30 pm PT (Virtual)

Wednesday 4:00 - 4:30 pm PT (In-Person in Vancouver Centre)

Thursday 5:00 - 5:30 pm PT (Virtual)

Friday 11:00 - 11:30 am PT (Virtual)

Is there anything else you would like us to know?

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InspireHealth Patient and Support Person Liability Waiver*

Assumption of Risk, Release of Liability, Waiver of Claims, and Indemnity Agreement

ASSUMPTION OF RISKS
I have voluntarily chosen to participate in classes, programs, services, and/or consultations with InspireHealth Society (“InspireHealth”) medical doctors, clinical counsellors, dietitians, exercise therapists and/or other InspireHealth team members or practitioners (the “Services”). The Services may be provided remotely and/or may be provided at an InspireHealth location in Vancouver, Victoria, Kelowna or elsewhere (the “Facilities”).

1. I am aware and understand that there are risks when I participate in the Services and/or use InspireHealth Facilities. Some risks can be anticipated and some cannot.
2. The risks of participating in the Services and of using InspireHealth Facilities include, but are not limited to risks of physical injury, examples of which include: shortness of breath, dizziness, exacerbation of symptoms of my cancer or cancer treatment, increased risk of slips, trips or falls, pain of unknown origin, strains, sprains, overexertion, dehydration, fatigue, aggravation of pre-existing conditions, headaches, tingling or other unusual physical sensations, weakness, nausea, serious injury, permanent or temporary disability, death; risk of adverse psychological effects or of psychological injury, examples of which include: anxiety, depression, irritability, nervousness, trouble sleeping, thoughts of self-harm; property damage; and social or economic losses.
3. Even if InspireHealth has assessed me and provided clearance for me to participate in the Services, this does not eliminate the risks.
4. I am aware of the contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (the "Disease") and that despite any efforts by InspireHealth to reduce the risk of exposure, I may be exposed to or contract the Disease by participating in the Services, by attending InspireHealth Facilities and/or by interacting with InspireHealth staff, contractors and/or members, and that the Disease may result in serious illness, physical injury, disability, death, expenses or other losses.
5. I understand, acknowledge and accept that negligent acts, omissions, advice, or a negligent failure to warn, protect or advise me on the part of InspireHealth and/or its officers, directors, employees, contractors, consultants, volunteers, agents, instructors, therapists, insurers, sponsors, donors, representatives, members, successors, assigns may cause or increase the risk that I will suffer physical injury, psychological injury, property damage, and social or economic loss.

I UNDERSTAND, ACKNOWLEDGE AND AGREE THAT I AM VOLUNTARILY PARTICIPATING IN THE SERVICES and/or ATTENDING THE FACILITIES, KNOWING THAT THERE ARE RISKS TO DOING SO. I AGREE TO ACCEPT AND ASSUME ALL RISKS OF PHYSICAL INJURY, PSYCHOLOGICAL INJURY, PROPERTY DAMAGE, SOCIAL AND ECONOMIC LOSS, DISABILITY, DEATH, AND ANY OTHER LOSS OF ANY KIND WHATSOEVER ARISING FROM OR IN ANY WAY CONNECTED WITH THE SERVICES, MY PARTICIPATION IN THE SERVICES AND/OR MY ATTENDANCE AND USE OF THE FACILITIES, INCLUDING THOSE CAUSED OR CONTRIBUTED TO BY THE NEGLIGENCE OF INSPIREHEALTH OR OTHERS FOR WHOM OR FOR WHICH INSPIREHEALTH IS RESPONSIBLE AT LAW.

RELEASE OF LIABILITY and WAIVER OF CLAIMS
As a precondition to participating in the Services, and as consideration for the value that I will receive by participating in the Services, I agree to all the terms and conditions in this Assumption of Risk, Release of Liability, Waiver of Claims, and Indemnity Agreement (“Agreement”).

I EXPRESSLY WAIVE ANY AND ALL CLAIMS which I have or which I may, in future, have against InspireHealth and/or its officers, directors, employees, contractors, consultants, volunteers, agents, instructors, therapists, insurers, sponsors, donors, representatives, members, successors, assigns and/or anyone who or which might claim contribution or indemnity from any one of them (collectively, the “Releasees”) DUE TO ANY CAUSE WHATSOEVER AND HOWSOEVER ARISING, including on account of any PHYSICAL INJURY, PSYCHOLOGICAL INJURY, PROPERTY DAMAGE, SOCIAL AND ECONOMIC LOSS, DISABILITY and/or, DEATH, examples of which are referred to above in the “Assumption of Risks” section of this Agreement, and including those arising from, or in any way connected to the Services, my participation in the Services, and/or my attendance at and/or use of InspireHealth Facilities.
For greater certainty, I expressly waive my right to seek compensation from any of the RELEASEES FOR ANY REASON WHATSOVER, including but not limited physical injury, psychological injury, property damage, social or economic loss, death and/or disability caused by negligent acts, omissions, advice, or a negligent failure to warn, protect or advise me by any of the RELEASEES, including any breach of any duty of care owed to me pursuant to the Occupiers Liability Act, R.S.B.C. 1996, c. 303, as amended.
I covenant not to make or bring any such claims against InspireHealth or any of the Releasees, and forever release and discharge InspireHealth and the other Releasees from liability under such claims.

INDEMNITY
I AGREE TO HOLD HARMLESS AND INDEMNIFY InspireHealth and the other RELEASEES from and against any injury, loss, damage, expense. liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties and fines OF ANY KIND WHATSOEVER and arising from or in any way connected with my membership with InspireHealth, my participation in the Services, and/or my attendance at or use of the Facilities, INCLUDING ALL RISKS AND CAUSES REFERENCED IN THE ASSUMPTION OF RISK AND RELEASE OF LIABILITY AND WAIVER OF CLAIMS sections of this Agreement, above.

ADDITIONAL TERMS
I further acknowledge and agree that:
1. Entire Agreement: This Agreement is the entire agreement between me and InspireHealth governing my participation in the Services and use of the Facilities.
2. Severability: If any term or provision of this Agreement is invalid or unenforceable for any reason, it shall be severed and not affect the validity and enforceability of the remaining terms or provisions.
3. Binding Agreement: This Agreement is binding on and shall benefit me, InspireHealth, the other Releasees and our respective heirs, executors, administrators, successors and assigns.
4. Governing Law: All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the Province of British Columbia and the federal laws of Canada applicable within that Province. Any claim or cause of action arising under this Agreement may be brought only in the courts of the Province of British Columbia, and I hereby consent to the exclusive jurisdiction of such courts.

I acknowledge and agree that by signing this Agreement, I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS (on my behalf and on behalf of my heirs, executors, administrators, and next-of-kin), INCLUDING THE RIGHT TO SUE INSPIREHEALTH AND THE OTHER RELEASEES FOR ANY REASON WHATSOEVER.

I am 19 years of age or older and not under a legal disability.

I agree to the Terms of Service

InspireHealth Patient and Support Person Liability Waiver

I agree to the Terms of Service

Assumption of Risk, Release of Liability, Waiver of Claims, and Indemnity Agreement

ASSUMPTION OF RISKS
I have voluntarily chosen to participate in classes, programs, services, and/or consultations with InspireHealth Society (“InspireHealth”) medical doctors, clinical counsellors, dietitians, exercise
therapists and/or other InspireHealth team members or practitioners (the “Services”). The Services may be provided remotely and/or may be provided at an InspireHealth location in Vancouver, Victoria, Kelowna or elsewhere (the “Facilities”).

1. I am aware and understand that there are risks when I participate in the Services and/or use
InspireHealth Facilities. Some risks can be anticipated, and some cannot.
2. The risks of participating in the Services and of using InspireHealth Facilities include, but are not limited to risks of physical injury, examples of which include: shortness of breath, dizziness,
exacerbation of symptoms of my cancer or cancer treatment, increased risk of slips, trips or falls, pain of unknown origin, strains, sprains, overexertion, dehydration, fatigue, aggravation of preu0002existing conditions, headaches, tingling or other unusual physical sensations, weakness, nausea, serious injury, permanent or temporary disability, death; risk of adverse psychological effects or of psychological injury, examples of which include: anxiety, depression, irritability, nervousness, trouble sleeping, thoughts of self-harm; property damage; and social or economic losses.
3. Even if InspireHealth has assessed me and provided clearance for me to participate in the
Services, this does not eliminate the risks.
4. I am aware of the contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (the "Disease") and that despite any efforts by InspireHealth to reduce the risk of exposure, I may be exposed to or contract the Disease by participating in the Services, by attending InspireHealth Facilities and/or by interacting with InspireHealth staff, contractors and/or members, and that the Disease may result in serious illness, physical injury, disability, death, expenses or other losses.
5. I understand, acknowledge and accept that negligent acts, omissions, advice, or a negligent
failure to warn, protect or advise me on the part of InspireHealth and/or its officers, directors,
employees, contractors, consultants, volunteers, agents, instructors, therapists, insurers,
sponsors, donors, representatives, members, successors, assigns may cause or increase the risk that I will suffer physical injury, psychological injury, property damage, and social or economic loss. I UNDERSTAND, ACKNOWLEDGE AND AGREE THAT I AM VOLUNTARILY PARTICIPATING IN THE SERVICES and/or ATTENDING THE FACILITIES, KNOWING THAT THERE ARE RISKS TO DOING SO. I AGREE TO ACCEPT AND ASSUME ALL RISKS OF PHYSICAL INJURY, PSYCHOLOGICAL INJURY, PROPERTY DAMAGE, SOCIAL AND ECONOMIC LOSS, DISABILITY, DEATH, AND ANY OTHER LOSS OF ANY KIND WHATSOEVER ARISING FROM OR IN ANY WAY CONNECTED WITH THE SERVICES, MY PARTICIPATION IN THE SERVICES AND/OR MY ATTENDANCE AND USE OF THE FACILITIES, INCLUDING THOSE CAUSED OR CONTRIBUTED TO BY THE NEGLIGENCE OF INSPIREHEALTH OR OTHERS FOR WHOM OR FOR WHICH INSPIREHEALTH IS RESPONSIBLE AT LAW.

RELEASE OF LIABILITY and WAIVER OF CLAIMS
As a precondition to participating in the Services, and as consideration for the value that I will receive by participating in the Services, I agree to all the terms and conditions in this Assumption of Risk, Release of Liability, Waiver of Claims, and Indemnity Agreement (“Agreement”). I EXPRESSLY WAIVE ANY AND ALL CLAIMS which I have or which I may, in future, have against InspireHealth and/or its officers, directors, employees, contractors, consultants, volunteers, agents, instructors, therapists, insurers, sponsors, donors, representatives, members, successors, assigns and/or anyone who or which might claim contribution or indemnity from any one of them (collectively, the “Releasees”) DUE TO ANY CAUSE WHATSOEVER AND HOWSOEVER ARISING, including on account of any PHYSICAL INJURY, PSYCHOLOGICAL INJURY, PROPERTY DAMAGE, SOCIAL AND ECONOMIC LOSS, DISABILITY and/or, DEATH, examples of which are referred to above in the “Assumption of Risks” section of this Agreement, and including those arising from, or in any way connected to the Services, my participation in the Services, and/or my attendance at and/or use of InspireHealth Facilities.

For greater certainty, I expressly waive my right to seek compensation from any of the RELEASEES FOR ANY REASON WHATSOVER, including but not limited physical injury, psychological injury, property damage, social or economic loss, death and/or disability caused by negligent acts, omissions, advice, or a negligent failure to warn, protect or advise me by any of the RELEASEES, including any breach of any duty of care owed to me pursuant to the Occupiers Liability Act, R.S.B.C. 1996, c. 303, as amended.

I covenant not to make or bring any such claims against InspireHealth or any of the Releasees, and forever release and discharge InspireHealth and the other Releasees from liability under such claims.
INDEMNITY

I AGREE TO HOLD HARMLESS AND INDEMNIFY InspireHealth and the other RELEASEES from and against any injury, loss, damage, expense. liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties and fines OF ANY KIND WHATSOEVER and arising from or in any way connected with my membership with InspireHealth, my participation in the Services, and/or my attendance at or use of the Facilities, INCLUDING ALL RISKS AND CAUSES REFERENCED IN THE ASSUMPTION OF RISK AND RELEASE OF LIABILITY AND WAIVER OF CLAIMS sections of this Agreement, above.

ADDITIONAL TERMS
I further acknowledge and agree that:
1. Entire Agreement: This Agreement is the entire agreement between me and InspireHealth
governing my participation in the Services and use of the Facilities.
2. Severability: If any term or provision of this Agreement is invalid or unenforceable for any reason, it shall be severed and not affect the validity and enforceability of the remaining terms or provisions.
3. Binding Agreement: This Agreement is binding on and shall benefit me, InspireHealth, the other
Releasees and our respective heirs, executors, administrators, successors and assigns.
4. Governing Law: All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the Province of British Columbia and the federal laws of Canada applicable within that Province. Any claim or cause of action arising under this Agreement may be brought only in the courts of the Province of British Columbia, and I hereby consent to the exclusive jurisdiction of such courts.

I acknowledge and agree that by signing this Agreement, I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS (on my behalf and on behalf of my heirs, executors, administrators, and next-of-kin), INCLUDING THE RIGHT TO SUE INSPIREHEALTH AND THE OTHER RELEASEES FOR ANY REASON
WHATSOEVER.

I am 19 years of age or older and not under a legal disability.

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Patient Sign Up

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Have you previously met with an Exercise Therapist at InspireHealth?*

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Have you attended an exercise class at InspireHealth in the past three months?*

Exercise Therapy Assessment

Safety is our primary consideration in all programming at InspireHealth. In order for us to ensure a safe environment in movement-based group classes, all patients attending an online exercise class must have had a consultation with an InspireHealth Exercise Therapist or attended a class in the last three months. The following questions will help us understand your health and your current exercise level.

Current activity level*

Currently active (achieving greater than 30 minutes of moderate intensity activity, three days per week for at least 3 months)

Low activity (less than 60 minutes of moderate intensity activity per week)

Inactive

Please check any current chronic conditions (in addition to cancer)

Please Specify:

What is a recent blood pressure reading (from a doctor’s office, pharmacy, etc)?*

Do you have any of the following:

Do you have any cancer in your bones?*

Yes

Please specify:

Have you had surgery within the last six months?*

Yes

Please specify:

Online Classes & Program Reminder

I would like to receive reminders about upcoming programs and classes.

InspireHealth eNewsletter Signup

I would like to subscribe to the InspireHealth Newsletter and receive upcoming programs, news, events and giving opportunities.

By checking this box, you understand that we will review your submission and be in touch with you shortly. Please make sure to add [email protected] and [email protected] to your safe sender's list and check your junk/spam folder.

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Functional Movement Class Registration

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Contact Information

New Patient Information

Patient Sign Up

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Exercise Therapy Assessment

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