Virtual Exercise & Falls Prevention Sign Up

If you are a new client to Circle of Care, or new to the service you are requesting, someone will follow up with you to gather additional information. Furthermore, they will determine eligibility of the service that you are requesting.

Please note that this is the sign up form for the Virtual Exercise Classes.

Are you currently a Circle of Care client?
YesNoOther

If you are not currently a Circle of Care client, please provide us with the following information:
Date of birth:

Your mailing address:

If you are a current client, what services have you received in the past?
Exercise & Falls PreventionADP (Adult Day ProgramPSW (Care from a Personal Support Worker)Social WorkMeals on WheelsHolocaust Survivor ProgramOther

Have you used the online video conferencing platform called Zoom before?
YesNo

If you have answered no to the previous question, do you have someone at home to help you use or set up Zoom?
YesNoMaybe

AGREEMENT: You hereby acknowledge, confirm and understand that access and use of an online portal/online environment has some inherent privacy and security risks including, without limitation, risks that your information may be intercepted or unlawfully accessed. We want to make sure you understand this before you proceed with use of our online portal/online platform. In order to safeguard your privacy as well as your personal and other confidential information, you should take certain steps to reduce the risk of unauthorized access to your account and personal and other confidential information. First, you should only access and use our online portal/online platform and your account in a private setting and you should not use someone else’s computer/device as they may be able to access your account information and, possibly, your personal and other confidential information. Services will commence on the date shown on your file and can be terminated by you, within 24 hours cancellation notice at any time. You further acknowledge, confirm and understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to forever and unconditionally release and discharge Circle of Home Care Services (Toronto) (cob Circle of Care) from any and all claims, causes of action and liabilities, whether known or unknown, arising out of Circle of Care’s virtual classes. Please be advised that the Circle of Care reserves the right to cancel or alter any program listed above in this form without notice and in its sole discretion for any reason whatsoever including, without limitation, insufficient registration numbers, change of policy, change of financial circumstances, technical issues and/or availability of instructors. *

 

  • When we are able to return to a physical world, please note that a Waitlist may be in effect to accommodate past & present participants due to class capacity
  • You must be 65+ to participate. If you do not meet this requirement, please contact Laura Tichonchuk (ltichonchuk@circleofcare.com)
  • Please note that the Zoom password will be sent within 24 hours of registering Monday- Thursday. If you register over the weekend, please note that you will receive the information no later than end of day on Monday.