Thank you for your interest in our Encore exercise and wellness program. To complete the enrolment process you will need to:

  1. Fill in the online Participant Enrolment Form below
  2. Have a Medical Approval form signed by one of your treating doctors, and
  3. Sign a Privacy form.

Download our Privacy Statement.

Please start your enrolment by completing the following form.

Program Details
Personal Details
We are committed to meeting disability or other support needs to assist you to participate in the Encore program. Please tick any of the following boxes if applicable. You will be contacted for more information prior to the course.
Emergency contact
Please define how your are related to your emergency contact, ie, sister, brother, friend.
Confidential Health Assessment

Download the YWCA Encore Privacy Statement.

Conditions

Do you have, or have you had, any of the following? (tick as appropriate)

Do you have trouble getting in and out of a pool?
List of Medications
Medication*Reasons for taking*
Please list any other relevant medical conditions that could affect your participation in ENCORE’s exercise program?

Please note the following

if you have an open wound you are not permitted to enter the water but may participate in the information and land exercise sessions.

If you are currently undergoing treatment you will need clearance from your treating specialist.

Details of breast surgery
Have you had further breast surgery (i.e., breast reconstruction, other)
Optional

Are you still undergoing treatment for your breast cancer?

Which part/s of the body are affected by lymphoedema
Please list other information relevant to your breast cancer surgery or treatment
Communication
Agreement

I wish to enrol in the YWCA Encore program facilitated by YWCA Australia. In doing so, I waive all and any claim, right or course of action against YWCA Australia, its officers and servants for any accident, or illness, which occurs during participation in the YWCA Encore program.

I further authorise the said officers or servants of YWCA Australia to administer first aid and/or procure medical assistance, as they may determine necessary, in the event of any illness or accident that may occur whilst attending the YWCA Encore program, and agree to meet any expenses incurred therein.

I acknowledge the terms of the attached Privacy Policy.

Consent Form

It is a prerequisite to participation in any Encore exercise program that all participants complete the YWCA Encore process which includes submitting a Medical Approval form signed by their medical practitioner before attempting the exercises in our videos and that they follow their doctor’s advice.

It is also a condition of participation in the online Encore program that you assume responsibility for exercising within your limits and that you assume all risk or injury to your person or property. To the extent permitted by law, YWCA Australia and YWCA Encore disclaim any and all liability in connection with the exercises in our online program and any instruction and advice provided.

Technique correction and guidance is limited due to the online nature of these virtual classes. Instructors might recommend you use household items including fixtures. This is only a recommendation and you should ensure items you choose to use are secure and suitable to withstand exercise requirements. You are responsible for the safety and suitability of the environment and space you choose to undertake these classes in.         

If at any time you feel you are excising beyond your current fitness abilities, or you feel discomfort, pain, dizziness, or nausea you should discontinue exercising immediately and seek professional medical advice.

I acknowledge the terms of the attached Privacy Policy.