Passport to Wellness F2025

Participant Name *

First

Last

Participant Age *

*Must be age 55 and above

How would you prefer we contact you? *

Phone Call
E-mail

Email *

Phone Number

Participant Gender *

Female
Male
Prefer not to say

In order to collect data that can support funding priorities, please share if you identify with any of the following: *

Newcome to Canada
Person with disability or functional limitations
BIPOC ( Black, Indigenous, People of Color)
None of the above apply to me
Prefer not to answer

Did you participate in the Winter Passport to Wellness Program? *

Yes I am back for more!
No, this is my first time!

I would like to sign up for the following: *

55+ Multi-Sport Program
55+ Floor Curling
55+ Functional Fitness
Intergenerational Cornhole
Play and Learn October 24 (Stretching/Recovery)
Play and Learn November 28 (Swimming/Nutrition)
Play and Learn December 12 (TBD)
Final Celebration December 17

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Emergency Contact Relationship *

Please complete our waiver online using the link below. If you have already completed a waiver in 2025 with the Wood Buffalo Sport Connection, you do not need to complete again. *

Completed
Unable to Complete

Copy and paste the following link in your browser: https://www.jotform.com/form/242616040793051

By signing the waiver, you have agreed to photo and video consent. If you do not consent to this please confirm below. *

I consent to photo/video release
I do not consent to photo/video release

Please identify any health/general program concerns we should be aware of including any food allergies.

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