Life Now course waitlist - Cancer Council WA

Life Now waitlist

Please select the course you would like to be waitlisted for:*

Please select which Exercise course you would like to be waitlisted for:*

BUNBURY Exercise: Mondays & Wednesdays, 12:30pm-1:00pm (1hr), 3 February - 30 April

COMO Exercise: Mondays & Wednesdays, 11:00am-12:00pm (1hr), 3 February - 30 April

FLOREAT Exercise: Tuesdays & Thursdays, 12:00pm - 1:00pm (1hr), 4 March - 22 May

MANDURAH Exercise: Tuesdays & Thursdays, 2:00pm - 3:00pm (1hr), 4 February - 24 April

Please select which Meditation course you would like to be waitlisted for:*

NARROGIN Meditation: Wednesdays, 2:00pm - 3:00pm (1hr) 19 February - 26 March

HARRISDALE Meditation: Wednesdays, 10:00am - 11:00am (1hr) 12 February - 19 March

HILLARYS Meditation: Wednesdays, 2:00pm - 3:00pm (1hr) 12 February - 19 March

ONLINE Meditation: Tuesdays, 11:00am - 12:00pm (1hr) 14 January - 18 February

ONLINE Meditation: Thursdays, 10:00am - 11:00pm (1hr) 6 February - 13 March

Please select which Mindful Art course you would like to be waitlisted for:*

FALCON Mindful Art: Fridays, 10:30am-12:00pm (1.5hr), 17 January – 21 February

MERRIWA Mindful Art: Fridays, 1:30Pm – 3:00pm (1.5hr), 7 February - 14 March

Please select which Mindfulness course you would like to be waitlisted for:*

BUSSELTON Mindfulness: Thursdays, 9:30am – 11:30am (2hrs) 20 February – 10 April

HILTON Mindfulness: Wednesdays, 10:00am – 12:00pm (2hrs), 5 February - 26 March

ONLINE Mindfulness: Thursdays, 2:00pm – 4:00pm (2hrs), 20 February - 10 April

Please select which Tai Chi course you would like to be waitlisted for:*

ONLINE Tai Chi: Wednesdays, 9:00am – 10:00am (1hr), 5 February - 12 March

KARAWARA Tai Chi: Thursdays, 11:00am – 12:00pm (1hr), 6 February - 13 March

ONLINE Tai Chi: Wednesdays, 6:00pm – 7:00pm (1hr), 19 February - 26 March

KARAWARA Tai Chi: Thursdays, 6:00pm – 7:00pm (1hr), 20 February - 27 March

Please select which Yoga course you would like to be waitlisted for:*

HAMILTON HILL Yoga: Wednesdays, 11:00am – 12:00pm (1hr), 15 January - 19 February

ONLINE Yoga: Thursdays, 10:00am – 11:00am (1hr), 16 January - 20 February

ONLINE Yoga: Thursdays, 5:00pm – 6:00pm (1hr), 30 January - 6 March

SHENTON PARK Yoga: Tuesdays, 4:00pm – 5:00pm (1hr), 18 February - 25 March

SORRENTO Yoga: Thursdays, 10:00am – 11:00am (1hr), 16 January - 20 February

ALBANY Yoga: Tuesdays, 11:00am – 12:00pm (1hr), 18 February - 25 March

GERALDTON Yoga: Wednesdays, 12:00pm – 1:00pm (1hr), 19 February - 26 March

Q: Are you the primary carer for someone who has been diagnosed with cancer within the last 2 years?

Yes

Course Eligibility - Exercise

Q: Individuals with any of the following health conditions are not eligible to participate in the Life Now Exercise program:*

I have read the health-related eligibility criteria and confirm that I am able to seek medical clearance to participate in the Exercise course

• Any musculoskeletal, cardiovascular or neurological disorder or acute illness that could place the participant at risk of injury. • Presence of myeloma bone disease • Severe anaemia (Hb < 80 g/L for men and women) • Neutropenia.

Q: Before the course starts, it is essential that each participant completes the forms provided in the Exercise Participant Pack and attends an initial assessment with the Accredited Exercise Physiologist facilitating the course (fee applies).*

I am aware of the pre-course requirements and can commit to completing them before the course commences.

Registrant Information

Name*

Prefix First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Date of Birth*

We ask for your date of birth to enable us to distinguish between participants of the same name.

What is the date of your diagnosis?*

What is your cancer type?*

Please provide the following details of the person you are primary career for

Name*

Prefix First Last

Date of Birth*

Cancer type*

Date of Diagnosis*

Emergency Contact

Name*

First Last

Relationship*

Phone*

How did you hear about our Life Now courses?*

Phone

This field is for validation purposes and should be left unchanged.