Walk With Ease Logging
Walk With Ease

The Kentucky Department for Public Health and Department for Aging and Independent Living is pleased to partner with the Center for Disease Control and Arthritis Foundation to offer Walk with Ease (WWE), a 6-week walking program to encourage people with or without arthritis to start walking and stay motivated to keep active anytime of the year. Participants will receive a workbook including educational materials and worksheets. You will also receive emails of encouragement along the way.

Participant benefits include: reduce the pain and discomfort of arthritis, improved balance, strength, and walking pace, build confidence in your ability to be physically active, manage ongoing health conditions and improve overall health.

Components of Walk with Ease include: managing arthritis pain and stiffness, stretching and strengthening activities to support the walking program, self-monitoring for physical problems while walking, anticipating and overcoming barriers to being physically active, getting and staying motivated to exercise, develop a walking plan that will meet your needs, and learning how to exercise safely.

Contact Information
First Name
*
Last Name
*
Address Line 1
*
Address Line 2
City
*
County
*
State
*
Zip/Postal Code
*
Email Address
*
Contact Phone (123) 456-7890
Demographics
Birth Year
*
Gender
*
Race/Ethnicity
*
  • Optional Questions
Chronic Conditions
State Government Employee
State Government Agency
State Gov. Building Name
HumanaVitality Participant
How did you find out about WWE
Participant Release
  • I understand and agree that there are risks, both foreseeable and unpredictable, associated with any exercise or education program.
  • I am aware of these risks and agree that my participation is at my own risk. I hereby agree that neither the Arthritis Foundation, nor any co-sponsoring agency or facility, not their respective chapters, officers, directors, employees, agents members or volunteers, shall assume or have any responsibility or liability for the expenses or medical treatment or for compensation for any injury I may suffer during or resulting from my participation in the Arthritis Foundation program, regardless of where any injury occurs or whether any such injury occurred in a formal or informal program.
  • I do hereby, for myself, my heirs, executors and administrators, waive, release, and forever discharge the Arthritis Foundation (and any related entities) and any co-sponsoring agency or facility (as well as their agents, employees and volunteers) from any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in this or any future Arthritis Foundation program.
  • I understand that this Participant Release has important legal consequences and limits my ability to recover money if I am injured as a result of my participation in this program. I have been given the opportunity to discuss its terms and consequences with an attorney of my choosing if I wish to do so. I also represent and warrant that I have been advised to seek consultation from my doctor about whether I can safely participate in this program and whether there are precautions or limitations to my participation.
  • I understand and agree that the goal of the Arthritis Foundation and the co-sponsoring facility is to provide a safe program environment free from disruption or harassment. To this end, the Arthritis Foundation and the co-sponsoring agency reserve the right to deny admission to those individuals whose behavior is disruptive, or who harass other program members or staff. I understand and agree that a copy of this release and registration information will be provided to the Arthritis Foundation as well as any co-sponsoring agency or facility. The Arthritis Foundation (and any related entities) and any co-sponsoring agency or facility may rely upon this Participant Release.
  • Contact Information shall not be disclosed to anyone without authorization.
By checking this box, you have read & accept the Arthritis Foundation Release.  *
 
Copyright © 2008 Commonwealth of Kentucky
All rights reserved.
CHFS Application Name