2024 Spring StrongBodies Registration- Statewide Virtual
The StrongBodies Program will help you increase your strength, bone density, balance, and energy!   Join StrongBodies today! 
Questions about the StrongBodies Program: strongbodies@extension.wisc.edu   



For communicative accommodations in languages other than English, please contact: oaic@extension.wisc.edu.

For communicative accommodations based on a disability, please contact: Heather Lipinski Stelljes at: heather.stelljes@wisc.edu.

An EEO/AA employer, the University of Wisconsin-Madison Division of Extension provides equal opportunities in employment and programming, including Title VI, Title IX, the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act requirements.  FoodWIse education is funded by the USDA Supplemental Nutrition Assistance Program– SNAP and Expanded Food and Nutrition Education Program - EFNEP.  
Email *
I would like to enroll in following StrongBodies class: *
First Name *
Last Name *
The number of times I have enrolled in 10-12 week sessions of StrongBodies: *
Phone Number *
Home Address (Street, City, Zip Code)
What COUNTY do you live in? *
Demographics: age in years *
Demographics: Gender *
Demographics: Race (Check ALL that apply) *
Required
Demographics: Ethnicity (pick one) *
Income:  Are any of these TRUE ?  (Note: This information is NOT shared and is only used to identify what funding UW-Extension uses for programming.)
 *
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In Case of Emergency, please call:  Include Name, Relationship, phone number. (ie Angela, Sister, 608-000-0000) *
Physical Activity Safety: Please read the statements below.  If you cannot answer no to all three statements, check with your primary care provider prior to registering for the virtual StrongBodies class. 

1. No, I DO NOT have Medical Condition such as heart disease, high blood pressure, diabetes, cancer, joint/bone problem,  respiratory disease, or any other medical condition that could be made worse by becoming more physically active.

2. No, I DO NOT currently Experience: chest discomfort with exertion, unreasonable breathlessness, dizziness, fainting, blackouts, ankle swelling, unpleasant awareness of a forceful, rapid, or irregular heart rate, burning or cramping sensations in lower legs when walking short distances, or known heart murmur.
3. No, My doctor has NEVER said that I should only do medically supervised physical activity or have any other reason that I should not do physical activity.

If you answered NO to all of the questions above:

Start becoming much more physically active. Begin slowly and build up gradually. This is the safest and easiest way to go.

Delay becoming much more active if:

You are not feeling well because of a temporary illness such as a cold or a fever. Wait until you feel better.

You are or may be pregnant. Talk to your doctor before you start becoming more active.

If your health changes so that you would answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity.

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Required
Participation Agreement
I desire to participate voluntarily in education activities with the University of Wisconsin-Madison Division of Extension. I understand that I am being asked to read each of the following paragraphs carefully. I know, understand, and appreciate the risks that are inherent in the Strong Bodies programs and activities. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. I understand that if I have questions about any of the terms contained in this agreement, I may contact the UW-Madison Division of Extension StrongBodies program (strongbodies@extension.wisc.edu).

Assumption of Risks:

I understand that physical activity related to the StrongBodies Program, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care
taken to avoid injuries. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movement involving speed and change of direction, and others involve sustained physical activity, which places stress on the cardiovascular system, and exposure to infectious disease. The specific risks vary from one activity to another, but in each activity the risks range from: 1) minor injuries or illness such as scratches, bruises, and sprains to 2) major injuries such as fractures, internal injuries, joint or back injuries, heart attacks, concussions, and severe illness to 3) catastrophic injuries including paralysis and death. I understand that the University has advised me to seek the advice of my physician before participating in this activity. I understand that I have been advised to have health and accident insurance in effect and that no such coverage is provided for me by the University or the State of Wisconsin. I know, understand, and appreciate the risks that are inherent in the above-listed programs and activities. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
 *
Optional: Media Release I understand while participating in any Activities, I may be photographed, filmed, or recorded. I hereby grant to StrongWomen/StrongPeople and its designees the irrevocable and unrestricted right to  use and publish in any manner or medium my name, my likeness, photographs and video of me (or in which I may be included),  and sound recordings of my voice, in whole or in part, solely for marketing, advertising, and promotional purposes and to alter  the same without restriction. *
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