top of page

BASE Senior Fitness Exercise Program Registration

The BASE Senior Fitness Exercise Program is designed to encourage healthy physical activity and fun social interaction for people age 55+.  Moderate physical activity is safe for most people.  However, some people should check with their doctor before they start becoming more physically active. 


Please take a few minutes to honestly answer the six questions in the box below.  They may help you to determine whether you should visit your doctor before you start the classes.  Common sense is your best guide as you answer the questions.  Please read carefully and answer yes or no.

Has your doctor ever told you that you have a heart condition and that you should only participate in physical activity that is recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do physical activity?
Yes
No
In the past month, have you had chest pain when you are not doing physical activity?
Yes
No
Do you lose your balance due to feeling dizzy, or do you ever lose consciousness?
Yes
No
Do you have bone or joint problems that could be made worse by increased physical activity?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No

If you answered YES to any of these questions, you should talk with your doctor before you begin the classes.  You may still be able to participate with your doctor’s approval.  If you have recently seen your doctor and been told to increase your activity and have not experienced any physical illness since that visit, you are probably safe to begin the classes.


If you answered NO to all the questions, you can be reasonably sure that it is safe for you to become more physically active through the program.  You are the best judge when you are overdoing exercise.  Take it slow and build gradually.


Please keep in mind if you have a temporary illness, such as a cold or a fever, it is better to take a break from classes and wait until you feel better.  If your health changes and you can answer YES to any of the above questions, tell your health professional.  Ask if it is best to alter your physical activity.

RSVP Liability Waiver & Permission Agreement

I understand that by completing this form, I am registering for the RSVP BASE Senior Fitness Exercise Program.  I will not hold RSVP, its volunteers, or the exercise site responsible in case of accident, injury, or loss as a result of participation in these exercise activities.  I also give permission for any photos of videos of my participation taken during the program to be used for future RSVP promotional materials.  I have read, understood, and completed the questionnaire on the reverse side.  Any questions I had were answered to my full satisfaction.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
bottom of page