Smoking Cessation

Smoking Cessation Enrollment Form

2016 Cooper-Clayton Smoking Cessation Classes:

Belknap Campus:
When: Fridays - August 19 - November 11
Where: Get Healthy Now Wellness Center (601 Presidents Blvd.)
Time: 5 p.m.— 5:30 p.m.

HSC Campus:

When: Fridays - September 2 - October 14
Where: James Graham Brown Cancer Center
Time: 12 p.m. - 2 p.m.

First Name

Last Name

Your E-Mail Address

Subject

Select a Class (Required)

Smoking Cessation

Day/Location: Choose one of the following

Friday - 5:00 p.m. - 5:30 p.m. GHN Wellness Center

Agreement

I certify that I am a UofL Employee/Retiree or their Spouse/Qualifying Adult

Agreement to Participate This is an agreement to participate in the Get Healthy Now Activity Program at the University of Louisville. By submitting this form, you are agreeing to the following: I understand that every precaution has been taken to provide the safest environment; however, I also understand it is impossible to prevent all accidents and incidents. Injuries include but are not limited to: cuts, scrapes, heat-related injuries, shin splints, joint injuries, muscle cramps, muscle strains, sprains, tendonitis, or death. To help reduce the risk of injury to yourself or other participants, the following safety rules need to be followed in class: 1. Follow all precautions given to you by a Get Healthy Now Fitness Specialist. 2. Monitor your physiological responses to the activity. 3. Avoid ballistic stretching. 4. Wear proper clothing and shoes. 5. Always warm-up and cool-down. 6. Stop activity if you do not feel well. I agree to follow the preceding safety rules as well as any others given in the program. I certify that I am physically capable to participate in physical fitness and understand I am free to discontinue activity any time I feel undue discomfort or stress. I will notify the Get Healthy Now if I have any medical contraindications that would preclude activity. I have read the preceding warnings and risks, and have had the hazards explained to me, and I have had an opportunity to ask questions and have them answered. I fully know and appreciate the risks inherent in physical fitness and am voluntarily participating in this activity.

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Smoking Cessation

2016 Cooper-Clayton Smoking Cessation Classes: