Apna Mind, Apna Body – Virtual Session Intake Form

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Exercise Waiver

Before you begin any new exercise program — even those designed for seniors, such as this one — make sure you are cleared by your doctor to participate in physical activity before beginning the program. If you experience any abnormal symptoms, you should stop the program and contact your physician. Remember, any movement is good for you and it is important to go at your own pace. Remember to breathe in from your nose and out from your nose and mouth as we go through each exercise. Wear proper footwear and comfortable clothing that allows you to move freely. For these online exercises, choose a solid, stable chair with an armrest that does not have wheels. Participating in exercise activities included on the Indus Community Services and Apna Health website site is done entirely at your own risk.

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Virtual Programming Confidentiality Agreement

I understand that, as an observer and participants I may see, hear, or be exposed to confidential
information about others, such as health information, and personal information and services received. I acknowledge that it is my responsibility to respect the privacy and confidentiality of this information. I will not access (audio record, video, etc.) use, or disclose any confidential
information I observe during the virtual session.

Signature - please use your mouse or touchscreen to draw your signature.
Once we have received your information we will contact you with the next step.
Should you have any questions feel free to email us at info@induscs.ca