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This document is an application form for participants to enroll in the South Shore Hospital's Community Exercise Program, including medical release statements and physician clearance requirements.
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How to fill out South Shore Hospital Community Exercise Program Participant Application and Medical Release Form
01
Obtain the South Shore Hospital Community Exercise Program Participant Application and Medical Release Form from the hospital's website or front desk.
02
Begin by filling out personal information such as your name, address, phone number, and email in the designated fields.
03
Provide your date of birth and any relevant insurance information if required.
04
Complete the health history section, detailing any medical conditions, medications, or previous injuries you may have.
05
Read the consent and release information carefully, ensuring you understand the terms and conditions of participating in the program.
06
Sign and date the form where indicated to confirm your consent and understanding.
07
If applicable, have a physician complete any required sections related to your medical clearance.
08
Review the entire form for completeness before submitting it.
09
Submit the completed form to South Shore Hospital either through email, mail, or in person as instructed.
Who needs South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
01
Individuals who wish to participate in the South Shore Hospital Community Exercise Program.
02
Those with pre-existing health conditions that require a medical release for engagement in physical activities.
03
Patients referred by healthcare providers for exercise and rehabilitation support.
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What is South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
The South Shore Hospital Community Exercise Program Participant Application and Medical Release Form is a document that participants of the program must complete to register for exercise classes and to release the hospital from liability in case of any injuries during participation.
Who is required to file South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
All individuals who wish to participate in the South Shore Hospital Community Exercise Program are required to file this form.
How to fill out South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
To fill out the form, participants should provide personal information such as their name, contact details, medical history, and any relevant health conditions. It may also require a signature to confirm understanding of the program and the medical release.
What is the purpose of South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
The purpose of the form is to ensure that the hospital has necessary participant information for safety and contact purposes, as well as to protect the hospital from legal claims related to injuries incurred during the exercise program.
What information must be reported on South Shore Hospital Community Exercise Program Participant Application and Medical Release Form?
Participants must report their full name, date of birth, emergency contact information, any pre-existing medical conditions, medications, and provide a signature to acknowledge the medical release.
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