More difficult over a period of time. A
more detailed description
Of this
program is attached. All Senior exercise programs will be administered
by trained personal,and they also have a CPR
And First Aid Certifications.
By completing the form below you are not
assuming any
Responsibility for our administration of
this program. If you know of any medical or any other reasons why this
participant should not exercise,please indicate on this form.
If you have any questions about the Active
Older Adults program,please feel free to call the YMCA(360) 452-9244
REPORT OF PHYSICIAN
_____ I know of no reason why the
applicant may not exercise.
_____ I believe the applicant can
exercise,but I urge caution:
_____________________________________________________________
_____________________________________________________________
_____ the applicant should not engage in
the following activities:
__________________________________________________________________________________________________________________________
_____ I recommend that the applicant NOT
exercise.
Physician’s
signature_____________________________ Date______
Address______________________________________Phone_________
City, State,
Zip_______________________________________________