Fresh Air for Health Care Weekly Registration Form
We will use the information contained in this form to get your equipment set and ready for you each time you join us. After your first visit, you will no longer need to complete the full form. Simply fill in the required fields and proceed with registration.
First Name *
Your answer
Last Name *
Your answer
Hospital Affiliation *
Have you attended a previous weekly clinic? *
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Your answer
Address
Your answer
Height
Your answer
Weight
Your answer
Age
Your answer
Ability Level (beginner, intermediate, advanced) *
Do you plan on skiing, snowboarding or snowshoeing this week? *
Do you plan on taking advantage of a lesson this week? *
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