Strech, Strength, and S'myelin' with M.S.

Offered on the second, third, and fourth Thursday of each month (and sometimes the fifth Thursday, too!) between 7:00 and 7:45 PM at the West Goshen Township Administration Building, this class is brought to you by the Greater Delaware Valley M.S. Society, the West Goshen Township Park and Recreation Department, and Ageless Exercise. Have multiple sclerosis? Myelin in your body not working as it should? Stretch and smile as you learn to relax, breathe, and learn the latest exercise techniques adapted to your own ability. Learn special exercises designed specifically for people with MS. This fitness program costs $25 per year to attend as many or as few sessions as you would like! Please note that anyone who signed up in 2008 needs to reregister for 2009.

To register, print this page, complete the information below, and return it with payment to: Park and Recreation Department, West Goshen Township, 1025 Paoli Pike, West Chester, PA 19380.

Name:__________________________________ Phone:_____________________________

Address:___________________________________________________________________

__________________________________________________________________________

Payment ($25 per person):_________________________

Medical Insurance Company:___________________________________________________

In case of Emergency, call (if different than home):____________________________________

I, the undersigned, intending to be legally bound for myself, my heirs, executors, administrators, and assigns, hereby waive and release any and all rights and claims for damages I may now or hereafter have against West Goshen Township and its respective employees for any and all damages or injuries which may be sustained by me or my family arising out of participation in the above activity.

_________________________________          ________________________________
 Signature*                                      Date

* Signature of parent or legal guardian if participant is under 18.