Registration

On the Move for Veterans

Thank you for your interest in our On the Move Training Program. This program is free and open to anyone regardless of experience or abilities.

Create Account

Creating an account allows you to track your progress across all of our programs.

First Name *

Last Name *

Address

City

State

ZIP Code *

Email *

Phone

Date of Birth *

Emergency Contact Name

Emergency Contact Phone

I am physically active

3 or more times per week

1 or 2 times per week

Occasionally when I can fit it in

Very little or none

What is your goal or motivation for joining this program?

Do you have any medical issues that we should know about?

Do you agree to the program waiver? *

Program Waiver

I hereby acknowledge and understand that participation in fitness classes and related activities conducted by Activate Oklahoma and Ernest Childers VA Outpatient Clinic (the Providers) involves certain risks and potential dangers. I voluntarily agree to participate in the class and assume all risks associated with my participation.

Assumption of Risk

I acknowledge that I am voluntarily participating in the fitness class(es) provided by the Providers. I understand that physical exercise, by its very nature, carries with it certain inherent risks, including but not limited to physical injury, strain, discomfort, and even the possibility of serious injury or death. I hereby assume all risks and responsibility for any such injuries or other medical incidents.

Waiver and Release

I hereby release, waive, discharge, and agree not to sue the Providers, its employees, representatives, affiliates, or agents from any claims, demands, liabilities, rights, damages, expenses, and causes of action of any nature arising out of or in connection with my participation in the fitness class(es), whether caused by the negligence of the Providers or otherwise.

Medical Representation

I represent that I am physically fit to participate in the fitness class(es) and have no medical condition that would prevent my safe participation. If I have any medical conditions or concerns, I have consulted with a healthcare provider and obtained clearance to participate.

Consent to Medical Treatment

I hereby consent to receive any necessary medical treatment resulting from my participation in the fitness class(es) and agree to bear all costs associated with such treatment.

Photography and Video Release

I hereby grant permission to the Providers to take and use photographs and videos of me for promotional purposes without compensation.

Acknowledgment

I have read this waiver, understand its contents, and agree to be bound by its terms. I understand that I am giving up substantial legal rights by signing this document.

Do you agree to complete the self evaluations? *

I hereby acknowledge and understand that participation in Activate Oklahoma’s training programs include periodic self-evaluations regarding mental health, physical health, and neighborhood safety. I agree that I will complete these forms in a timely manner when requested. I understand that not meeting these requirements may result in becoming ineligible in future program benefits.

Do you agree to our Code of Conduct? *

Activate Oklahoma provides a welcoming and comfortable environment for all of our participants. We expect all participants to support these standards of conduct during our activities.

Clients/guests are expected to be respectful of other participants and staff.
Clients may not use profane, abusive, or loud/boisterous language while on the premises or engage in any action that may be discourteous or harmful to others.
Clients/guests are expected to interact appropriately with other participants, staff, and guests. Behavior should not violate another person's sense of privacy or dignity.
Clients/guests may not make threats, fight, or engage in any inappropriate or unwanted physical contact with another person.
Clients/guests suspected to be under the influence of alcohol or illegal drugs will not be allowed admission into the facility.
Clients/guests participating in group exercise classes are expected to be respectful of the instructor and other participants and should not engage in disruptive behavior of any kind.
Clients/guests are expected to maintain confidentiality regarding any other client’s program participation.
Violations of any of these rules may result in termination in this program and exclusion from future programs with Activate Oklahoma and our partners.

* Required Information