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2. The LPR Health & Wellness Division is offering an evidence-based wellness program designed specifically for the workplace. The workshop is FREE to all and will be scheduled based on demand. Space for the program is limited to 12 participants and available on a first come first served basis.
4. First Name*
5. Last Name*
7. Email Address*
9. Employer / Department*
11. Please read through the program description below, select whether you are interested or not interested in the program and when you prefer that we offer the program.
13. Living a Healthy Life Chronic Conditions in the Workplace*

    This program is designed to help working adults who live with a chronic condition improve their self-confidence in their ability to manage their symptoms, develop healthy behaviors and improve health status. Sessions are held for one hour, two times per week for 6 weeks. Each session of the program is highly interactive.
    
    Topics Addressed During the Workshops Include: Techniques to help balance work and home life, how to deal with frustration, fatigue, pain, and isolation, ways to maintain and improve strength, flexibility, and endurance, managing medications, effective communication with family, friends, and health professional, healthy eating, goal setting and More!
    
    

    1. I would be interested in participating virtually
    2. Not interested
15. What is your preferred time for the virtual program? (select all that apply):*

    1. Weekdays during the lunch hour
    2. Weekdays in the evenings
17. How important is physical activity in your life?*

    1. Not Important
    2. Somewhat Important
    3. Very Important
    4. Crucial
19. Please site your current percieved stress level from 0-10, with 0 being low stress and 10 being high stress

    1. 1
    2. 2
    3. 3
    4. 4
    5. 5

    1. 6
    2. 7
    3. 8
    4. 9
    5. 10
21. Participation Waiver
    I am over the age of 18 and acknowledge I have been informed of the need for a physician’s approval for my participation in wellness programming. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this program, I acknowledge I am doing so at my own risk.
    
    I understand and am aware that health and wellness programming includes potentially risky activities. I am voluntarily participating in these activities with knowledge of the potential risks. I hereby agree to hold harmless Liberty Parks & Recreation, its respective representatives, executors, agents, and assigns from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected to my participation in any and all wellness programming.
    
    I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Liberty Parks & Recreation, its respective representatives, executors, and/or assigns.
    
    * I have read the above information and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
23. Acknowledgement*

    1. I Agree
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25. Submit

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