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2. Liberty Parks & Rec is launching virtual evidence-based programs to improve the health of the community. These groups will be be developed based on demand and are FREE to all. Please submit request to join all groups you would be interested in.
4. First Name*
5. Last Name*
7. Date of Birth*
8. Email Address*

   By submitting your email you are opting in to receive emails from Liberty Parks & Rec about these programs.

10. Evidence-Based Programs
    Please read through the program descriptions below and select whether you are interested in the program or it does not interest you.
12. Active Living Every Day*

    Active Living Every Day presents a scientifically tested step-by-step program with behavior change strategies for becoming more physically active in your day. You will learn simple and enjoyable ways to fit physical activity into your life. Learn how every day activities like housecleaning and gardening can count toward your weekly physical activities goal and develop confidence by learning problem solving skills and how to overcoming obstacles.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating remotely by telephone
    3. I would be interested in participating in-person
    4. Not interested
14. Aging Mastery Program*

    Aging Mastery is a comprehensive and fun approach to living that celebrates the gift of longevity. Central to the Aging Mastery philosophy is the belief that modest lifestyle changes can produce big results and that people can be empowered to cultivate health and longevity. Equally important, the program encourages mastery—developing sustainable behaviors across many dimensions that will lead to improved health, stronger financial security, enhanced well-being, and increased connectedness to communities. The path to mastery is entirely individual. Individuals set their own goals and create their own pathways to these goals, opening the door to autonomy and purpose in the process. This program is 10 weeks long with 90 minute classes each week.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating in-person
    3. Not interested
16. Circle of Friends®*

    The overall goal of the Circle of Friends® intervention is to alleviate and prevent loneliness for older adults. Circle of Friends® allows members to meet new people, engage in meaningful activities and discussions, and share feelings of loneliness. This group based, goal- oriented intervention encourages group members to share input with facilitators and influence the content of meetings. The aim is that members will build strong relationships with one another and continue to meet independently once the formal group has concluded.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating remotely by telephone
    3. I would be interested in participating in-person
    4. Not interested
18. Diabetes Self-Management*

    The American Diabetes Association identifies this program as meeting the Diabetes Support Initiative criteria for support programming. Each session of the workshop is very interactive allowing participants to build confidence in their ability to manage their health and maintain active and fulfilling lives through mutual support and success. Workshops are 2.5 hours long and held once per week over a seven week period of time with plenty of socializing breaks built into each session. Topics covered in the workshop include: Techniques to deal with symptoms of diabetes, pain, fatigue and hyper/hypoglycemia, strategies to manage emotional problems such as depression, fear and frustration, healthy eating, appropriate use of medications, working effectively with healthcare providers and more.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating remotely by telephone
    3. I would be interested in participating in-person
    4. Not interested
20. Healthy Eating Every Day*

    Whether you’re looking for ways to improve the quality of what you eat, are you trying to balance calories to reach a healthy weight, need a total diet makeover or just a tweak here and there, Healthy Eating Every Day has the answers for you! This program will empower you to change your eating habits for a lifetime with fun and simple, whole-diet approaches that do not eliminate food groups or require you to cut out meals. Learn to identify and cope with triggers that lead to poor eating; identify methods to eat well when dining out; create shopping lists for healthy foods within your budget; read and understand food labels and eat a balanced diet that includes foods you enjoy. Healthy Eating Every Day helps you get on track and helps you stay there. Workshops are 1 hour long for 14 weeks.

    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating in person
    3. Not interested
22. Matter of Balance*

    A Matter of Balance is an 8-week structured group intervention that emphasizes practical strategies to reduce fear of falling and increase activity levels. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. NO VIRTUAL OPTION, this program is offered in-person only.
    
    Select all that apply:

    1. I would be interested in participating in-person
    2. Not interested
24. Steps to Healthier Living with Chronic Conditions*

    This is an interactive evidence-based workshop designed for adults living with a chronic condition such as arthritis, diabetes, heart disease, lung disease, as well as adults who care for someone with a chronic condition. This workshop focuses on helping adults manage their chronic conditions through goal setting; stress, anxiety and depression management, physical activity, healthy eating, appropriate use of medication and effective communication with health care providers, family and friends. Workshops are 2.5 hours long and held once per week over a 6 week period of time with plenty of socializing breaks built into the workshops.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating remotely by telephone
    3. I would be interested in participating in-person
    4. Not interested
26. Steps to Healthier Living with Chronic Pain*

    Chronic pain is a daily challenge that includes many types of conditions from various causes. This is a virtual and interactive evidence-based program. The program is designed to help you manage your health and maintain an active and fulfilling life with self-management tools and techniques that work best for you. The workshop focuses on helping adults manage their chronic pain through goal setting; techniques that help manage frustration, fatigue, isolation, and poor sleep, physical activity, healthy eating and appropriate use of medication, as well as, effectively communicating with health care providers, family and friends. Workshops are 2.5 hours long and held once per week over a 6 week period of time with plenty of socializing breaks built into the workshops.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested in participating remotely by telephone
    3. I would be interested in participating in-person
    4. Not interested
28. Walk With Ease*

    Walk with Ease is a fitness program shown to relieve pain and improve health. This evidence- based program was developed by experts at the Arthritis Foundation and helps participants build up and maintain a successful walking routine. If participants can be on their feet for 10 minutes without increased pain they can have success with this program. This program is twice per week for 6 weeks. Virtual option offers education and stretching in a closed group virtual classroom and walking independently.
    
    Select all that apply:

    1. I would be interested in participating virtually
    2. I would be interested participating in-person
    3. Not interested
30. What is your preferred time for programs?*

    Select all that apply:

    1. Weekdays during the day
    2. Weekdays in the evening
    3. Weekends
32. If you are interested in more than one program, which program would you be most interested in first?
    -- Select One --Active Living Every DayAging Mastery ProgramCircle of Friends®Diabetes Self-ManagementMatter of BalanceSteps to Healthier Living with Chronic ConditionsSteps to Healthier Living with Chronic PainWalk With Ease
34. How important is physical activity in your life?*

    1. Not Important
    2. Somewhat Important
    3. Very Important
    4. Crucial
36. Please site your current percieved stress level from 0-10, with 0 being low stress and 10 being high stress

    1. 1
    2. 2
    3. 3
    4. 4
    5. 5

    1. 6
    2. 7
    3. 8
    4. 9
    5. 10
38. Participation Waiver
    I am over the age of 18 and acknowledge I have been informed of the need for a physician’s approval for my participation in wellness programming. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this program, I acknowledge I am doing so at my own risk.
    
    I understand and am aware that health and wellness programming includes potentially risky activities. I am voluntarily participating in these activities with knowledge of the potential risks. I hereby agree to hold harmless Liberty Parks & Recreation, its respective representatives, executors, agents, and assigns from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected to my participation in any and all wellness programming.
    
    I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Liberty Parks & Recreation, its respective representatives, executors, and/or assigns.
    
    * I have read the above information and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
40. Acknowledgement*

    1. I Agree
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42. Submit

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