I have a valid 2020 WSAC membership.
I consent to participate in a customized small group physical activity program with KIN 385 students from the University of Alberta.
I am able to meet weekly for 13 weeks, on Thursdays, from September 1 to December 3, 2020 inclusive at 2:00 pm to 3:00 pm. Activities will involve a variety of activities, including 8 weeks of exercise sessions.
I have a technology device, such as a computer or iPad, as well as an internet connection to use in order to participate in the program.
I understand that the program will be delivered via online, live Zoom meetings and that I can receive training for using Zoom. In order to receive training, I agree to contact Shelley Kulak, WSAC’s Recreation Program Manager, by email at email@example.com.
I consent to answer questions concerning my current levels of physical activity participation and my lifestyle.
I understand that information gathered during the interview conducted by the KIN 385 students will be used to determine the most appropriate physical activity for my current level of functioning.
I understand that the KIN 385 students I am working with will provide professional guidance only within their scope of knowledge and experience.
I understand that there are potential risks during participation in physical activity (i.e. episodes of transient lightheadedness, loss of consciousness, abnormal blood pressure, chest discomfort, leg cramps, and nausea), in rare instances heart rhythm disturbances or heart attacks, and that I assume willfully those risks.
I am obliged to immediately inform the KIN 385 students of any pain, discomfort, fatigue or any other symptoms that I may experience during and immediately after participating in physical activity.
I understand that I may stop or delay any further participation in physical activity if I so desire and that the KIN 385 students may terminate the physical activity session upon observation of any symptoms of undue distress or abnormal response.
I understand that I may ask questions or request further explanation or information about the physical activity program at any time.
I understand that the KIN 385 students are not obligated to provide guidance once the course has finished.
I acknowledge that I have read, understood, and completed the health questionnaire portion of this survey fully and answered all of the questions. I understand that, in order to participate, I need to fully answer all questions, including further information, as needed and have consulted with a health care provider or Qualified Exercise Professional prior to becoming active.
I acknowledge that the undergraduate students are learning and I agree to provide constructive feedback as required to help them learn how to facilitate exercise for older adults.
That I will adhere to the WSAC Member Code of Conduct and I will:
a. Behave in a courteous and respectful manner toward others.
b. Be tolerant and patient with the limitations and weaknesses of others.
c. Be respectful of the individual and cultural differences of others.
d. Be considerate of the feelings of others.
e. Refrain from behavior that is abusive, threatening, offensive or disruptive to others.
f. Act honestly and ethically in relationships with others, including University staff and students as well as WSAC members, volunteers and staff.
g. Fully understand that, according to WSAC policies, behavior outside of the code of conduct may result in my suspension or expulsion from activities with Westend Seniors Activity Centre. I also understand that I can access the full Code of Conduct, in writing, by speaking with any staff member from the centre and as such, agree to adhere to the behaviors and expectations contained within.
By signing this agreement, I am agreeing to provide my consent for Westend Seniors Activity Centre to release my email address to the University of Alberta’s KIN 385 Associate Teaching Professor, Dr. Joanna Auger, for the sole purpose of Zoom program facilitation. My consent will be valid between August 1, 2020 and December 31, 2020.