GROUP FITNESS SCHEDULE FALL 2019 - BE FIT...

10
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 - Level 1 4600 Tuesday / Thursday 12:00-12:55 PM Dance Studio Kettle + Conditioning - Level 2 4700 Tuesday / Thursday 12:00-12:55 PM HFC Total Body Training - Level 1 5000 Monday / Wednesday 1:00-1:55 PM HFC Total Body Training - Level 2 5100 Monday / Wednesday 12:00-12:55 PM HFC Total Body Training - Level 2 5101 Monday / Wednesday 5:30-6:25 PM HFC Yoga 5400 Monday / Wednesday 12:00-12:55 PM Dance Studio Yoga 5401 Tuesday / Thursday 5:30-6:25 PM HFC Express Yoga + Pilates 5700 Tuesday / Thursday 11:30AM - 12:00PM Dance Studio Note: HFC = Health Fitness Center Bellefield Hall Pilates + Sculpt 4800 Monday / Wednesday 1:00-1:55 PM Dance Studio Total Body Training - Level 1 5001 Monday / Wednesday 7:00-7:55 AM Dance Studio Total Body Training - Level 1 5002 Tuesday / Thursday 4:30-5:25 PM Dance Studio Total Body Training - Level 2 5102 Tuesday / Thursday 7:00-7:55 AM Dance Studio Total Body Training - Level 2 5103 Tuesday / Thursday 12:00-12:55 PM Dance Studio Total Body Training - Level 2 5104 Tuesday / Thursday 5:30-6:25 PM Dance Studio Yoga 5402 Tuesday / Thursday 1:00-1:55 PM 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 Note: Classes located on 2 nd Floor William Pitt Union Classes at Union reserved for PITT Faculty & Staff only Express Yoga + Pilates 5701 Monday / Wednesday 7:15-7:45 AM Dance Studio Express Yoga + Pilates 5702 Tuesday / Thursday 7:15-7:45 AM Dance Studio Note: Classes located on 3 rd Floor DROP-IN $5 FRIDAY CLASSES 12:00-12:45 PM EVERY FRIDAY: 9/6 12/20 TREES HALL Classes Begin: Monday, 9/3 Classes End: Friday, 12/6 No Classes: Labor Day: Monday, 9/2 Thanksgiving Week: Monday, 11/25 - Friday, 11/29 GROUP FITNESS SCHEDULE FALL 2019

Transcript of GROUP FITNESS SCHEDULE FALL 2019 - BE FIT...

Page 1: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

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 - Level 1 4600 Tuesday / Thursday 12:00-12:55 PM Dance Studio

Kettle + Conditioning - Level 2 4700 Tuesday / Thursday 12:00-12:55 PM HFC

Total Body Training - Level 1 5000 Monday / Wednesday 1:00-1:55 PM HFC

Total Body Training - Level 2 5100 Monday / Wednesday 12:00-12:55 PM HFC

Total Body Training - Level 2 5101 Monday / Wednesday 5:30-6:25 PM HFC

Yoga 5400 Monday / Wednesday 12:00-12:55 PM Dance Studio

Yoga 5401 Tuesday / Thursday 5:30-6:25 PM HFC

Express Yoga + Pilates 5700 Tuesday / Thursday 11:30AM - 12:00PM Dance Studio

Note: HFC = Health Fitness Center

Bellefield Hall Pilates + Sculpt 4800 Monday / Wednesday 1:00-1:55 PM Dance Studio

Total Body Training - Level 1 5001 Monday / Wednesday 7:00-7:55 AM Dance Studio

Total Body Training - Level 1 5002 Tuesday / Thursday 4:30-5:25 PM Dance Studio

Total Body Training - Level 2 5102 Tuesday / Thursday 7:00-7:55 AM Dance Studio

Total Body Training - Level 2 5103 Tuesday / Thursday 12:00-12:55 PM Dance Studio

Total Body Training - Level 2 5104 Tuesday / Thursday 5:30-6:25 PM Dance Studio

Yoga 5402 Tuesday / Thursday 1:00-1:55 PM 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 Note: Classes located on 2nd Floor

William Pitt Union Classes at Union reserved for PITT Faculty & Staff only

Express Yoga + Pilates 5701 Monday / Wednesday 7:15-7:45 AM Dance Studio

Express Yoga + Pilates 5702 Tuesday / Thursday 7:15-7:45 AM Dance Studio Note: Classes located on 3rd Floor

DROP-IN $5 FRIDAY CLASSES

12:00-12:45 PM EVERY FRIDAY: 9/6 – 12/20 TREES HALL

Classes Begin: Monday, 9/3 Classes End: Friday, 12/6

No Classes: Labor Day: Monday, 9/2 Thanksgiving Week: Monday, 11/25 - Friday, 11/29

GROUP FITNESS SCHEDULE FALL 2019

Page 2: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

PRICING:

$55 PITT ID $65 UPMC/VA ID

$85 NO PITT/UPMC/VA ID

PERSONALIZED FITNESS PROGRAMMING Included at NO COST with your Fitness Center Membership!

New! Extended Hours

FITNESS CENTER SCHEDULE FALL 2019

Fitness Center Opens: Monday, 8/26 Fitness Center Closes: Friday, 12/20

No Access: Labor Day: Monday, 9/2 Thanksgiving Break: Thursday, 11/28 - Friday, 11/29

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.

Page 3: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

Name:

Address: City: State: Zip:

Telephone Number: ( ) Email Address:

PITT ID: Yes No Provide number here:

UPMC/VA ID: Yes No Provide number here:

UPMC/VA/Community Members Only: Do you currently have a Healthy Lifestyle Institute Facility Guest Pass? Yes No Provide number here:

Join Email List? Yes No (newsletters, announcements, class updates) New Member? Yes No

CLASS NUMBER Cost with PITT ID

Cost with UPMC/VA ID

Cost without PITT/UPMC/VA

ID CHOICE COST

Indoor Cycling 4400 $55 $60 $70

Indoor Cycling 4401 $55 $60 $70

Indoor Cycling 4402 $55 $60 $70

Kettle + Conditioning – Level 1 4600 $55 $60 $70

Kettle + Conditioning – Level 2 4700 $55 $60 $70

Pilates + Sculpt 4800 $55 $60 $70

Total Body Training – Level 1 5000 $55 $60 $70

Total Body Training – Level 1 5001 $55 $60 $70

Total Body Training – Level 1 5002 $55 $60 $70

Total Body Training – Level 2 5100 $55 $60 $70

Total Body Training – Level 2 5101 $55 $60 $70

Total Body Training – Level 2 5102 $55 $60 $70

Total Body Training – Level 2 5103 $55 $60 $70

Total Body Training – Level 2 5104 $55 $60 $70

Yoga 5400 $55 $60 $70

Yoga 5401 $55 $60 $70

Yoga 5402 $55 $60 $70

Express Yoga + Pilates 5700 $40 $45 $55

Express Yoga + Pilates 5701 $40 $45 $55

Express Yoga + Pilates 5702 $40 $45 $55

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 Friday classes) $60 $60 $60

TOTAL DUE

STEP 1 – PAYMENT METHOD: PITT PAYROLL DEDUCTION: CHECK: CHECK PAYABLE TO: “UNIVERSITY OF PITTSBURGH”

STEP 2 – COMPLETE ALL FORMS: REGISTRATION FORM, HEALTH SCREENING FORM, MEDICAL CLEARANCE (IF REQUIRED), & RELEASE FORM

STEP 3 – DELIVER REGISTRATION: DELIVERY FORMS + PAYMENT TO TREES HALL 140

STEP 4 – CONFIRMATION: THE BE FIT PITT TEAM WILL EMAIL YOU A CONFIRMATION OF YOUR ENROLLMENT

KEY INFORMATION: REFUNDS ONLY GIVEN WITHIN 1 WEEK OF ENROLLMENT, LESS $5.00 $20.00 FEE ASSESSED FOR A RETURNED CHECK ALL FORMS + PAYMENT MUST BE PROCESSED BEFORE PARTICIPATION CAN BEGIN

Office Use Only: REG PMT HIF Phy Rel Initials _____

REGISTRATION FORM FALL 2019

Questions? 412-648-8320

[email protected]

Page 4: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

Total Body Training (formerly Bootcamp Fitness):

This exciting class is full of fun challenges to keep our participants engaged and achieving a full body workout. "TBT" incorporates calisthenics and strength training with aerobic exercise bouts. Look for something different and challenging with each class session.

BE FIT PITT offers 2 levels of “TBT” making the class accessible for the beginner to advanced participant.

Level 1 – Classes designed to focus on the basic skills needed to safely and effectively perform calisthenics or body weight exercise and other strength training movements. This is a great recommendation for first-time “TBT” participants or those preferring to take their workouts a little slower.

Level 2 – Classes designed for the more experienced “TBT” exerciser wanting to move through workouts at a faster and more intense pace. Variation and modifications will always be presented; however, it is recommended that participants have a basic background in body weight and strength exercise prior to attending this faster pace class.

Not sure which class is best for you? Speak to one of our BE FIT PITT Health Fitness Specialists to find the perfect fit. [email protected]

Indoor Cycling:

Designed for all levels, this cycling class offers a challenging opportunity to get your heart pumping, burn calories, and leave you with a feeling of accomplishment and perhaps a desire to be out on the road.

Pilates + Sculpt:

This non-aerobic workout is designed to condition and tone the muscles of the body. Balls, bands, free weights and even your own body weight can be used during this class to create a total body workout. Pilates exercise will also be incorporated to tone and sculpt the body. The class is easily tailored for beginner to intermediate exercisers.

CLASS DESCRIPTIONS

FALL 2019

Page 5: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

Kettle + Conditioning:

Kettle bells can be an effective training tool to add to any cardio or strength regimen. This class is designed to incorporate this tool within a class that provides a total body conditioning workout. Instructors will educate on proper form and safety within a challenging workout.

BE FIT PITT offers 2 levels of Kettle + Conditioning making the class accessible for the beginner to advanced participant.

Level 1 – Classes designed to focus on the basic skills needed to safely and effectively perform kettle bell and other strength and circuit training movements. This is a great recommendation for first-time kettle bell participants or those preferring to take their workouts a little slower.

Level 2 – Classes designed for the more experienced kettle bell exerciser wanting to move through workouts at a faster and more intense pace. Variation and modifications will always be presented; however, it is recommended that participants have a basic background in kettle bell methods and strength exercise prior to attending this faster pace class.

Not sure which class is best for you? Speak to one of our BE FIT PITT Health Fitness Specialists to find the perfect fit. [email protected]

Express Yoga + Pilates:

Stretch, Tone, Restore, and Find Balance with this 30-minute class. Designed to give you all the benefits of Yoga and Pilates, but on shorter time-frame for busy schedules. Appropriate for all levels, beginner to advanced.

Yoga:

A form of physical activity that enhances both the physical and mental states. This class involves full body postures to improve muscle tone, flexibility, focus and body awareness. Please provide your own mat.

Zumba®:

This one of a kind combination of dance and exercise is designed to put "fun" back into fitness. The Zumba® workout maximizes conditioning and total body toning. This class features aerobic interval training with a combination of fast and slow rhythms. A party-like atmosphere is created with the exotic and explosive rhythms of the music. No previous dance experience is needed to have fun with Zumba®!

Page 6: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

SUBSCRIBE TO OUR EMAIL LIST FOR THE WEEKLY CLASS OFFERING REMINDER!

ENROLLMENT INSTRUCTIONS:

OPTION 1: WEEKLY DROP-IN o RESPOND TO THE WEEKLY EMAIL TO RESERVE YOUR SPOT o PAY $5 AT THE DOOR

OPTION 2: “PAY IT FORWARD FRIDAY” o GUARANTEED SPOT IN A CLASS EACH FRIDAY o PAY FOR ALL 15 CLASSES IN ADVANCE – RECEIVE CLASSES FOR FREE!

SCHEDULE DATE CLASS OPTION 1* CLASS OPTION 2*

9/6 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

9/13 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

9/20 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

9/27 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

10/4 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

10/11 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

10/18 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

10/25 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

11/1 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

11/8 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

11/15 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

11/22 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

11/29 NO CLASS NO CLASS

12/6 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

12/13 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

12/20 TOTAL BODY TRAINING - LEVEL 1 TOTAL BODY TRAINING - LEVEL 2

*Waiver required to participate

EVERY FRIDAY - TREES HALL - 12:00-12:45 PM

FRIDAY FITNESS SCHEDULE FALL 2019

First Class: Friday, 9/6 Last Class: Friday, 12/20

No Class: Thanksgiving Break Friday, 11/29

Page 7: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

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, 2019 through June 30, 2020 (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

Page 8: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

2

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

Page 9: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

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), experienced any chest pain, discomfort, pressure or tightness in your chest? Or had jaw or radiating pain down your arms?

NO YES

During the past 12 months have you experienced difficulty breathing or had shortness of breath?

NO YES

Are you currently or have you ever been under physician care for, or been told by a physician that you have, a heart or lung condition?

NO YES

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 pressure?

NO YES

Do you have total cholesterol greater than 200 mg/dl or HDL cholesterol less than 35 mg/dl or are you being treated for high cholesterol?

NO YES

Do you have bone or joint (back, knee, hip) pain that could be made worse by a change in your activity level?

NO YES

Do you have a blood relative who had a heart attack or heart surgery before the age of 55 (men) or 65 (women)?

NO YES

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?

NO YES

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 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.

Page 10: GROUP FITNESS SCHEDULE FALL 2019 - BE FIT PITTbefitpitt.pitt.edu/.../uploads/2017/04/ALL-FORMS-COMBINED_FALL-2019.pdf · effectively perform calisthenics or body weight exercise and

PHYSICIANCONSENTTOPARTICIPATEINEXERCISE,WELLNESS,HEALTHANDFITNESSPROGRAMSATTHEUNIVERSITYOFPITTSBURGH

TO: PARTICIPANTISTORETURNTHISTO: Physician’sName HealthandFitnessPrograms

DepartmentofHealthandPhysicalActivity UniversityofPittsburgh Address

City State Zip () TelephoneNumber

Yourpatient______________________________(printpatient’sname)hasaskedtoparticipateincertainvoluntaryexercise,wellness,healthandfitnessprogramsattheUniversityofPittsburgh.Aspartoftheenrollmentprocesshe/shehasresponded“yes”tooneormorequestionsofaUniversityHealthInformationForm(exampleisattached),whichrequiresphysicianclearancepriortohim/herenrollinginthedescribedprogramsand/oruseaUniversityfitnessfacilityinconjunctionwiththedescribedprograms.Thispatientmayenrollinand/orhaveaccesstosomeorallthefollowingequipmentandprograms,asaresult:1. Cardiovasculartrainingequipmentsuchastreadmills,bicycles,ellipticaltrainers,etc.2. Resistancetrainingequipmentthatincludesacircuitofequipmentandfreeweights.3. Fitnessclassesthatincludebutarenotlimitedtoaerobics,yoga,pilates,andotherformsof

cardiovascularandstrengthtrainingactivities.4. Healthenhancementclassesthatmayincludebutarenotlimitedtonutritioneducation,

weightmanagement,etc.******************************************************************************Pleaseindicatebelowifthisprogramisappropriateforyourpatient,identifiedabove,orifyouseeanycontraindicationsforhis/herparticipation(pleasechecktheappropriateboxbelow).o Iknowofnocontraindicationstothispatientparticipatinginanyoftheabovedescribed

activitiesattheUniversityofPittsburgh.o Ifeelthatparticipationinphysicalactivityandotherhealthenhancementinitiatives

availablethroughthedescribedactivitiesattheUniversityofPittsburghwouldnotbeappropriateforthispatientforthefollowingreason(s):

SignatureofPhysician Date

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