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PVFC Membership Request

The Parkwood Virtual Fitness Centre (PVFC) is a live, virtual, adaptive fitness program for adults with disabilities and/or mobility impairments. Complete this form to request membership — our team reviews every request, and if approved you'll be sent an email invitation to set up your account.

Section of 2:

General

First name *

Last name *

Who is completing this form? *

I am completing this form for myself Other

Email address *

Phone *

Postal Code *

How did you learn about the PVFC?

Health care provider (e.g., physician, physiotherapist, occupational therapist) Health care provider not at Parkwood (e.g., physician, physiotherapist, occupational therapist) Personal contact (e.g., friend, family member) Scientist or researcher SCI Ontario Flyer/poster Other

Injury/Diagnosis *

Please select all that apply

Brain Injury Cerebral Palsy (CP) Guillain-Barré syndrome (GBS) Multiple Sclerosis (MS) Spinal Cord Injury (SCI) Stroke Other

Please provide any additional relevant details about your injury/diagnosis

E.g., level of injury, date of injury/diagnosis, symptoms

Do you have a disability and/or mobility impairment that limits your ability to access exercise equipment and programs in the community? *

Yes No

Class Time Preferences (optional)

This information will be used when we are creating the new class schedule for each term. Feel free to skip this section.

What days of the week would you prefer to attend classes?

Please select all that apply

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

What times would you prefer to attend classes on weekdays (Monday - Friday)?

Please select all that apply

Mornings between 7:00 AM - 10:00 AM Mornings between 10:00 AM - 12:00 PM Afternoons between 12:00 PM - 2:00 PM Afternoons between 2:00 PM - 5:00 PM Evenings after 5:00 PM

What times would you prefer to attend classes on weekends (Saturday and Sunday)?

Please select all that apply

Mornings between 7:00 AM - 10:00 AM Mornings between 10:00 AM - 12:00 PM Afternoons between 12:00 PM - 2:00 PM Afternoons between 2:00 PM - 5:00 PM Evenings after 5:00 PM

Already approved and invited? Sign in