Classes Begin: Monday, 5/7/2018 Classes End: Friday, 8/10/2018 No Class: Memorial Day: 5/28/2018 & Independence Day: 7/4/2018 Trees Hall Indoor Cycling 4400 Monday / Wednesday 12:00-12:55 PM HFC Indoor Cycling 4401 Tuesday / Thursday 5:30-6:25 PM HFC Indoor Cycling 4402 Tuesday / Thursday 6:30-7:25 AM HFC Kettle + Conditioning 4600 Tuesday / Thursday 12:00-12:55 PM HFC Pilates + Sculpt 4800 Tuesday / Thursday 12:00-12:55 PM Dance Studio Total Body Training 5000 Monday / Wednesday 12:00-12:55 PM HFC Total Body Training 5001 Monday / Wednesday 5:30-6:25 PM Dance Studio Yoga 5400 Monday / Wednesday 12:00-12:55 PM Dance Studio Yoga + Pilates 5600 Monday / Wednesday 7:00-7:55 AM HFC Bellefield Hall Note: HFC = Health Fitness Center Pilates + Sculpt 4801 Monday / Wednesday 1:00-1:55 PM Dance Studio Total Body Training 5002 Monday / Wednesday 7:00-7:55 AM Dance Studio Total Body Training 5003 Tuesday / Thursday 12:00-12:55 PM Dance Studio Total Body Training 5004 Tuesday / Thursday 5:30-6:25 PM Dance Studio Yoga 5401 Tuesday / Thursday 1:00-1:55 PM Dance Studio Yoga + Pilates 5601 Tuesday / Thursday 7:00-7:55 AM Dance Studio Zumba 5800 Monday / Wednesday 12:00-12:55 PM Dance Studio Zumba 5801 Monday / Wednesday 4:30-5:25 PM Dance Studio Zumba 5802 Monday / Wednesday 5:30-6:25 PM Dance Studio Add a Fitness Center Membership for a small additional price! *$20 per semester **$30 per semester ***$40 per semester $5 FRIDAY CLASSES ARE BACK! 12:00-12:45 PM (5/11/18 8/17/18) TREES HALL Email announcement of classes each week! Drop-in and Finish the Week Strong!
Fitness Center Opens: Monday, 4/30/2018 Fitness Center Closes: Saturday, 8/25/2018 No Access: Memorial Day: 5/28/2018 & Independence Day: 7/4/2018 The Healthy Lifestyle Institute operates the Trees Hall Fitness Center This provides a unique opportunity to engage PITT Faculty and Staff and the Pittsburgh Community in our innovative physical activity approaches. Bringing Research into Practice. New! Extended AM Hours Reduced pricing when combined with a Group Fitness Class! PERSONALIZED FITNESS PROGRAMMING Included at NO COST with your Fitness Center Membership!
Starting: Friday, 5/11/2018 Last Class: Friday, 8/17/2018 DATE SCHEDULE CLASS 5/11 TOTAL BODY TRAINING 5/18 INDOOR CYCLING 5/25 KETTLE BELL + CONDITIONING 6/1 YOGA 6/8 TOTAL BODY TRAINING 6/15 PILATES + SCULPT 6/22 TOTAL BODY TRAINING 6/29 INDOOR CYCLING 7/6 KETTLE BELL + CONDITIONING 7/13 TOTAL BODY TRAINING 7/20 YOGA 7/27 TOTAL BODY TRAINING 8/3 TOTAL BODY TRAINING 8/10 INDOOR CYCLING 8/17 TOTAL BODY TRAINING EACH WEEK AN EMAIL REMINDER WILL BE SENT ANNOUNCING THE UPCOMING CLASS. PARTICIPANTS ARE STRONGLY ENCOURAGED TO EMAIL BACK (EACH WEEK) TO RESERVE THEIR SPOT IN THE CLASS! BLOCK SPACE ON YOUR CALENDAR TO JOIN US EACH FRIDAY! BRING YOUR CO-WORKERS, FRIENDS, AND FAMILY PURCHASE ALL $5 FRIDAY CLASSES IN ADVANCE AND RECEIVE A 10% DISCOUNT! FINISH THE WEEK STRONG! *Waiver required for participation
Questions? 412-648-8320 befit@pitt.edu Name: Address: City: State: Zip Code: *Telephone Number: ( ) *Email Address: PITT ID: o Yes o No Provide number here: UPMC ID: o Yes o No Provide number here: UPMC/Community Members Only: Do you currently have a Healthy Lifestyle Institute Facility Guest Pass? o Yes o No Provide number here: Join Email List? o Yes o No (newsletters, announcements, class updates) *Required in the event that you need to be contacted regarding your application or class enrollment. CLASS NUMBER Cost with PITT ID Cost with UPMC ID Cost without PITT/UPMC ID Indoor Cycling 4400 $55 $60 $70 Indoor Cycling 4401 $55 $60 $70 Indoor Cycling 4402 $55 $60 $70 Kettle Bell + Conditioning 4600 $55 $60 $70 Pilates + Sculpt 4800 $55 $60 $70 Pilates + Sculpt 4801 $55 $60 $70 Total Body Training 5000 $55 $60 $70 Total Body Training 5001 $55 $60 $70 Total Body Training 5002 $55 $60 $70 Total Body Training 5003 $55 $60 $70 Total Body Training 5004 $55 $60 $70 Yoga 5400 $55 $60 $70 Yoga 5401 $55 $60 $70 Yoga + Pilates 5600 $55 $60 $70 Yoga + Pilates 5601 $55 $60 $70 ZUMBA 5800 $55 $60 $70 ZUMBA 5801 $55 $60 $70 ZUMBA 5802 $55 $60 $70 Fitness Center with Class Choice $20 $30 $40 Fitness Center without Class Choice $55 $65 $85 Pay it Forward Friday (purchase all Fridays ahead) $58 $58 $58 CHOICE COST TOTAL DUE Make check payable to the University of Pittsburgh. Only checks are accepted as a method of payment. Return this Registration Form, payment (check only), Health Screening Form, Medical Clearance Form (if required), and Release Form to the following: Department of Health and Physical Activity, University of Pittsburgh 140 Trees Hall, Pittsburgh, PA 15260 It is recommended that participants deliver forms in-person (8:30am-4:30pm Mon.-Fri.) to reduce processing delay. You will receive confirmation of your registration. A refund, less $5.00 per class, will only be given within 1 week of enrollment. $20 fee will be assessed for a returned check. Office Use Only: REG PMT HIF Phy Rel Initials
RELEASE REQUIRMENT SUMMER 2018 PLEASE NOTE THAT 2 RELEASE FORMS MUST BE COMPLETED TO COVER THE SUMMER 2018 TERM. DOCUMENTS HAVE BEEN COMBINED FOR YOUR CONVENIENCE. REVIEW ALL PAGES AND SIGN AND HAVE THE DOCUMENT WITNESSED WHERE INDICATED. MAKE SURE THAT ALL PAGES REQUIRING SIGNATURES INCLUDE BOTH THE PARTICIPANT AND WITNESS SIGNATURES. THIS DOCUMENT IS REQUIRED FOR PARTICIPATION IN THE PROGRAM FOR SUMMER 2018. THANK YOU FOR YOUR COOPERATION AND FOR YOUR MEMBERSHIP. HAVE A WONDERFUL AND HEALTHY SEMESTER!
RELEASE USE: To be used by participants in Exercise, Wellness, Health and Fitness Programs in the Department of Health and Physical Activity at the University of Pittsburgh This is a legally-binding Release, Waiver, Discharge and Covenant Not to Sue made by me to the University of Pittsburgh - Of the Commonwealth System of Higher Education ( University ). It is my desire to participate in one or more of the exercise, wellness, health and fitness classes/programs conducted by the University s Department of Health and Physical Activity and/or to make use of fitness facilities and/or fitness equipment owned, leased, or used by the University, during the period July 1, 2017 through June 30, 2018 (collectively, the Activity ). I fully recognize that there are dangers and risks to which I may be exposed by voluntarily participating in the Activity. Examples of these dangers and risks are injuries or conditions including, without limitation, damage to bone, muscle, nerve and/or soft tissue, lacerations, abrasions, contusions, fractures, heart attack, concussion, heart complication, aggravation of pre-existing condition, as well as other injuries or conditions, up to and including serious physical injury or impairment or loss of life. I appreciate the character of the risk taken and voluntarily assume all risk of harm. I understand that the University does not require me to participate in the Activity, but I want to do so, despite the possible dangers and risks and despite this Release. I therefore agree to assume and take on myself all of the risks and responsibilities in any way associated with my participation in the Activity. In consideration of and return for the opportunity to participate in the Activity, and for the services, facilities, equipment or other things provided to me by the University, I HEREBY RELEASE THE UNIVERSITY (AND ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, CONTRACTORS, VOLUNTEERS AND AGENTS) (COLLECTIVELY THE UNIVERSITY RELEASEES ) FROM ANY AND
ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME, UP TO AND INCLUDING DEATH, AND FROM DAMAGE TO MY PROPERTY, IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY. I UNDERSTAND THAT THIS RELEASE COVERS LIABILITY, CLAIMS AND ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURES TO ACT OF THE UNIVERSITY RELEASEES, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE. I recognize that this Release means I am giving up, among other things, rights to sue the University Releasees for injuries, damages or losses I may incur. I also understand that this Release binds my heirs, executors, administrators and assigns, as well as myself. Further, I agree to defend, indemnify and hold harmless the University Releasees from and against any claim, damage, liability, injury, expense or loss, including but not limited to, reasonable attorney fees, by reason of any suit, claim, demand, judgment or cause of action arising out of my participation in the Activity. I assure the University that, to the best of my knowledge, information and belief, I am physically able to participate in the Activity without any undue or unusual risk to me or to others. I acknowledge that the University has recommended that I consult with, have a physical examination conducted by, and follow the related instructions of a physician before I engage in the Activity. Finally, I understand and agree that the University may need to respond to accidents or emergency situations that may occur. Therefore, I hereby give my consent to the administration of any and all medical treatment of me the University deems necessary resulting from my participation in the Activity, with the understanding that the costs of any such treatment will be my responsibility. I am at least eighteen years of age and have read this entire Release. I fully understand it and I agree to be legally bound by it. THIS IS A RELEASE OF YOUR RIGHTS. Witness: READ CAREFULLY BEFORE SIGNING. Releasor s Signature Printed Name Date
RELEASE USE: To be used by participants in Exercise, Wellness, Health and Fitness Programs in the Department of Health and Physical Activity at the University of Pittsburgh This is a legally-binding Release, Waiver, Discharge and Covenant Not to Sue made by me to the University of Pittsburgh - Of the Commonwealth System of Higher Education ( University ). It is my desire to participate in one or more of the exercise, wellness, health and fitness classes/programs conducted by the University s Department of Health and Physical Activity and/or to make use of fitness facilities and/or fitness equipment owned, leased, or used by the University, during the period July 1, 2018 through June 30, 2019 (collectively, the Activity ). I fully recognize that there are dangers and risks to which I may be exposed by voluntarily participating in the Activity. Examples of these dangers and risks are injuries or conditions including, without limitation, damage to bone, muscle, nerve and/or soft tissue, lacerations, abrasions, contusions, fractures, heart attack, concussion, heart complication, aggravation of pre-existing condition, as well as other injuries or conditions, up to and including serious physical injury or impairment or loss of life. I appreciate the character of the risk taken and voluntarily assume all risk of harm. I understand that the University does not require me to participate in the Activity, but I want to do so, despite the possible dangers and risks and despite this Release. I therefore agree to assume and take on myself all of the risks and responsibilities in any way associated with my participation in the Activity. In consideration of and return for the opportunity to participate in the Activity, and for the services, facilities, equipment or other things provided to me by the University, I HEREBY RELEASE THE UNIVERSITY (AND ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, CONTRACTORS, VOLUNTEERS AND AGENTS) (COLLECTIVELY THE UNIVERSITY RELEASEES ) FROM ANY AND
ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME, UP TO AND INCLUDING DEATH, AND FROM DAMAGE TO MY PROPERTY, IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY. I UNDERSTAND THAT THIS RELEASE COVERS LIABILITY, CLAIMS AND ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURES TO ACT OF THE UNIVERSITY RELEASEES, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE. I recognize that this Release means I am giving up, among other things, rights to sue the University Releasees for injuries, damages or losses I may incur. I also understand that this Release binds my heirs, executors, administrators and assigns, as well as myself. Further, I agree to defend, indemnify and hold harmless the University Releasees from and against any claim, damage, liability, injury, expense or loss, including but not limited to, reasonable attorney fees, by reason of any suit, claim, demand, judgment or cause of action arising out of my participation in the Activity. I assure the University that, to the best of my knowledge, information and belief, I am physically able to participate in the Activity without any undue or unusual risk to me or to others. I acknowledge that the University has recommended that I consult with, have a physical examination conducted by, and follow the related instructions of a physician before I engage in the Activity. Finally, I understand and agree that the University may need to respond to accidents or emergency situations that may occur. Therefore, I hereby give my consent to the administration of any and all medical treatment of me the University deems necessary resulting from my participation in the Activity, with the understanding that the costs of any such treatment will be my responsibility. I am at least eighteen years of age and have read this entire Release. I fully understand it and I agree to be legally bound by it. THIS IS A RELEASE OF YOUR RIGHTS. Witness: READ CAREFULLY BEFORE SIGNING. Releasor s Signature Printed Name Date 5
Health Information Form Step 1: Individuals who participate in the University of Pittsburgh Health and Fitness Programs offered by the University s Department of Health and Physical Activity must complete and submit this Health Information form prior to participating in these programs. Please answer the following questions honestly and accurately. During the past 12 months, have you at anytime (at rest or during activity), NO YES experienced any chest pain, discomfort, pressure or tightness in your chest? Or had jaw or radiating pain down your arms? During the past 12 months have you experienced difficulty breathing or NO YES had shortness of breath? Are you currently or have you ever been under physician care for, or been NO YES told by a physician that you have, a heart or lung condition? Do you have asthma or another lung disease? NO YES Have you experienced dizziness, fainting or blacking out? NO YES Have you been diagnosed with diabetes? NO YES Have you been diagnosed with or are you being treated for high blood NO YES pressure? Do you have total cholesterol greater than 200 mg/dl or HDL cholesterol NO YES less than 35 mg/dl or are you being treated for high cholesterol? Do you have bone or joint (back, knee, hip) pain that could be made worse NO YES by a change in your activity level? Do you have a blood relative who had a heart attack or heart surgery NO YES before the age of 55 (men) or 65 (women)? Have you had recent surgery? NO YES If you are a female, are you currently or have you in the past six months been pregnant? Are you aware of any other reason why you should consider limiting your physical activity or avoid increasing your current level of physical activity? NO NO YES YES Step 2: If you answer yes to any question above, download the Physician s Consent Form at (www.physicalactivity.pitt.edu\healthandfitness) and have your personal physician complete this form. Step 3: Complete the information below. I attest that the information provided above is accurate to the best of my knowledge. Print Name: Signature: Date: Step 4: Bring this form with you when you register for this program. NOTE: If you answered yes to any of the above questions, the completed and signed Physician s Consent Form, by which your physician clears you for participation, must accompany this form prior to you participating in the Health and Fitness Programs.
University of Pittsburgh Department of Health and Physical Activity BE FIT PITT 140 Trees Hall University of Pittsburgh Pittsburgh, PA 15261 Phone: (412) 648-8320 Fax: (412) 648-7092 TO: PHYSICIAN CONSENT TO PARTICIPATE IN EXERCISE, WELLNESS, HEALTH AND FITNESS PROGRAMS AT THE UNIVERSITY OF PITTSBURGH Physician s Name Address PARTICIPANT IS TO RETURN THIS TO: Health and Fitness Programs Department of Health and Physical Activity University of Pittsburgh City State Zip ( ) Telephone Number Your patient (print patient s name) has asked to participate in certain voluntary exercise, wellness, health and fitness programs at the University of Pittsburgh. As part of the enrollment process he/she has responded yes to one or more questions of a University Health Information Form (example is attached), which requires physician clearance prior to him/her enrolling in the described programs and/or use a University fitness facility in conjunction with the described programs. This patient may enroll in and/or have access to some or all the following equipment and programs, as a result: 1. Cardiovascular training equipment such as treadmills, bicycles, elliptical trainers, etc. 2. Resistance training equipment that includes a circuit of equipment and free weights. 3. Fitness classes that include but are not limited to aerobics, yoga, pilates, and other forms of cardiovascular and strength training activities. 4. Health enhancement classes that may include but are not limited to nutrition education, weight management, etc. ****************************************************************************** Please indicate below if this program is appropriate for your patient, identified above, or if you see any contraindications for his/her participation (please check the appropriate box below). o I know of no contraindications to this patient participating in any of the above described activities at the University of Pittsburgh. o I feel that participation in physical activity and other health enhancement initiatives available through the described activities at the University of Pittsburgh would not be appropriate for this patient for the following reason(s): Signature of Physician Date