Montana Walk with Ease: Self-Directed

Completing this survey will register you for the Walk with Ease: Self-Directed program.

Required Information: To participate, please enter your first and last name, city, county, age, and email address. Any further personal information you provide is up to your discretion and not required for participation.

The information collected in this registration will be protected for your privacy. The Walk with Ease: Self-Directed leaders and the selected Department of Public Health & Human Services—Chronic Disease Prevention & Health Promotion Bureau staff will be able to view the information submitted.

How this information will be used: All information will be de-identified and compiled to demonstrate the value of this program to state and federal policy makers and community organizations.

Once you register: Upon registration completion, you will receive a confirmation email from donotreply@chronicdiseasedata.org and your Walk with Ease: Self-Directed leaders will be in contact with you at least one week before the scheduled start date.

If you have any questions or would like additional information, please email chronicdiseaseprevention@mt.gov

I acknowledge that participation by me is expressly conditioned on my agreement to each of the terms of this document. I acknowledge and agree as follows:

  1. My participation in Walk with Ease: Self-Directed offered by State of Montana HCBD is a voluntary activity. I voluntarily assume full responsibility for any injury, risks or losses that may occur as a result of my participation in the class or program.
  2. Physical exercise, sport, and recreational activities may cause injury. I understand there is an inherent risk of injury when choosing to participate in any physical exercise, sport, wellness, and/or recreational activities. I understand that the class or program may involve strenuous physical activity, and I hereby affirm that I am in good health and sufficient physical condition to properly participate in the class or program. I have been advised by State of Montana HCBD to consult with a healthcare provider before I undertake any physical exercise program.
  3. I acknowledge that State of Montana HCBD may utilize third party service providers to provide online platform that will be used as part of the Walk with Ease: Self-Directed program, which include but not limited to using video, chat, and microphone functions.