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Feel Good Tuesday - Movement and a Cuppa with Bec Registration Form
First name
Last name
Email
Phone
Emergency contact name and phone number
Do you have a injury or pain?
Yes
No
Do you get dizzy or lose balance?
Yes
No
Are you pregnant or did you recently have a baby?
Yes
No
Do you have hard‑to‑move or sore joints? (Example: stiff neck, sore knees, hard to lift arms.)
Yes
No
Did you have surgery or medical treatment recently?
*
Do you use anything to help you move? (Example: cane, walker, wheelchair, brace.)
Are there any movements you must not do? (Example: bending forward, twisting, lifting arms high.)
Do you have heart, breathing, or blood pressure problems?
Heart problem
Blood pressure problem
Breathing problem
None of these problems
Register
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