Classes Begin: Tuesday, 9/5/2017 Classes End: Friday, 12/8/2017 No Class: Labor Day: 9/4/2017 & Thanksgiving Break: 11/23-24/2017 Trees Hall Kettle + Conditioning Fitness Kickboxing Fitness Kickboxing Pilates Barre + Pilates Water Fitness Water Fitness Yoga Yoga + Pilates 4400 4401 4402 4403 4600 4700 4701 4800 4900 5000 5001 5002 5200 5201 5400 5600 6:45-7:40 AM 5:30-6:25 PM 6:45-7:40 AM 1:00-1:55 PM 5:15-6:10 PM 1:00-1:55 PM 4:15-5:10 PM 5:30-6:25 PM 7:00-7:55 AM 6:30-7:25 PM 6:45-7:40 AM Pool Pool Note: = Health Fitness Center Bellefield Hall Body Sculpting Yoga Yoga + Pilates Zumba Zumba Zumba 4000 5003 5004 5005 5401 5601 5800 5801 5802 Add a Fitness Center Membership for a small additional price! *$20 per semester **$30 per semester ***$40 per semester 1:00-1:55 PM 7:00-7:55 AM 5:30-6:25 PM 1:00-1:55 PM 7:00-7:55 AM 4:30-5:25 PM 5:30-6:25 PM $5 FRIDAY CLASSES ARE BACK! 12:00-12:45 PM (9/8/17 12/15/17) TREES HALL Email announcement of classes each week! Drop-in and Finish the Week Strong!
Fitness Center Opens: Monday, 8/28/2017 Fitness Center Closes: Thursday, 12/21/2017 No Access: Labor Day: 9/4/2017 & Thanksgiving Break: 11/23-24/2017 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. PERSONALIZED FITNESS PROGRAMMING Included at NO COST with your Fitness Center Membership! Reduced pricing when combined with a Group Fitness Class!
Starting: Friday, 9/8/2017 Last Class: Friday, 12/15/2017 No Class: Thanksgiving Break: 11/24/2017 SCHEDULE DATE 9/8 9/15 9/22 9/29 10/6 10/13 10/20 10/27 11/3 11/10 11/17 11/24 12/1 12/8 12/15 CLASS OPTIONS* INDO CYCLING FITNESS KICKBOXING YOGA BARRE + PILATES INDO CYCLING KETTLE BELL + CONDITIONING YOGA PILATES INDO CYCLING FITNESS KICKBOXING YOGA NO CLASS THANKSGIVING BREAK INDO CYCLING YOGA KETTLE BELL + CONDITIONING *Waiver required for participation 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 OF THE WEEK! BLOCK SPACE ON YOUR CALENDAR TO JOIN US EACH FRIDAY! BRING YOUR CO-WKERS, FRIENDS, AND FAMILY PURCHASE ALL $5 FRIDAY CLASSES IN ADVANCE AND RECEIVE A 10% DISCOUNT! * *Includes automatic enrollment in each week. Spots will still need to be reserved for specialty classes due to limited space. LET S FINISH THE WEEK STRONG!
Name: Address: City: State: *Preferred Telephone Number: *Preferred Email Address: Do you have a (circle) PITT or UPMC ID: o Yes o No Zip Code: Provide number here: *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 Body Sculpt Kettle Bell + Conditioning Fitness Kickboxing Fitness Kickboxing Pilates Barre + Pilates Water Fitness Water Fitness Yoga Yoga Yoga & Pilates Yoga & Pilates ZUMBA ZUMBA 4000 4400 4401 4402 4403 4600 4700 4701 4800 4900 5000 5001 5002 5003 5004 5005 5200 5201 5400 5401 5600 5601 5800 5801 $20 $63 $30 $65 $63 $40 $85 $63 ZUMBA 5802 Fitness Center with Class Choice Fitness Center without Class Choice Pay if Forward Friday (purchase all Fridays ahead) CHOICE TOTAL DUE JOIN OUR EMAIL LIST? o Yes o No Newsletters, Announcement, and Weekly $5 Class updates! COST Questions? 412-648-8320 befit@pitt.edu 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. Office Use Only: A refund, less $5.00 per class, will only be given within 1 week of enrollment. REG PMT HIF Phy Rel Initials A $20 fee will be assessed for a returned check.
USE: RELEASE 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, CONTRACTS, VOLUNTEERS AND AGENTS) (COLLECTIVELY THE UNIVERSITY RELEASEES ) FROM ANY AND ALL LIABILITY, CLAIMS AND ACTIONS THAT MAY ARISE FROM INJURY 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 IN PART BY ANY ACTS FAILURES TO ACT OF THE UNIVERSITY RELEASEES, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, MISTAKE 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 BEFE SIGNING. Releasor s Signature Printed Name Date 2
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