Thank you for your interest in CAPA’s Peer Movement Program!

This 12-week (7 live sessions) virtual program brings together people living with arthritis, patient experts, movement leaders, and other experts to explore enjoyable and adaptable ways to move, manage pain and fatigue, build healthy habits, and connect with others.

Please complete this short registration and pre-screening form. Your responses will help us understand your needs, identify any accommodations that may help you participate, and determine whether any follow-up is needed before you take part in the peer support program and movement sessions.

CAPA will keep the personal information you provide through this registration form private and will only use it for purposes related to administering and safely delivering the Move Well Live Well Program. Your information will only be shared with CAPA team members and, where necessary, program facilitators or movement leaders who need the information to support your participation. CAPA will not share your personal information with other participants or outside organizations without your permission, except where required by law or where there is a serious and immediate concern about safety.
Participant Information

Question Title

Name (Required.)

Question Title

Province/Territory

Question Title

Are you 18 years of age or older?

Question Title

Can you attend all of the weekly one-hour sessions?
They will be held on the following days from 1:00–2:00 p.m. PT / 4:00–5:00 p.m. ET, with the October 6 session taking place from 2:00 - 3:00 pm PT / 5:00 - 6:00 pm ET
(check all that you can attend)

Question Title

Diagnosis (optional)

Question Title

Emergency Contact Name

Question Title

Emergency Contact Phone Number

Accessibility & Participation

Question Title

Do you require any accessibility accommodations to participate in the program?

Question Title

Are there any communication preferences or other support that would help you to participate fully?

Self-Assessment of Movement
We want everyone to participate in a way that feels comfortable and appropriate for them. Because this program includes gentle physical activity, we ask everyone to complete a brief movement readiness screening.

Question Title

Has a healthcare professional advised you to avoid physical activity or only participate under medical supervision?

Question Title

Are you currently experiencing a health issue, recent injury or surgery, or other concern that could affect your ability to safely participate in gentle physical activity?

Question Title

Have you recently experienced unexplained chest pain, fainting, severe dizziness, or unusual shortness of breath during physical activity?

If you answer Yes or Unsure to any of these questions, it does not necessarily mean you cannot participate. A member of the CAPA team may contact you to discuss your response and may recommend that you speak with an appropriate healthcare professional before participating in the movement portions of the program.
Program Cost
CAPA aims to make all our programs accessible and sustainable. For this small-group program, we are inviting participants to make a $25 donation as a way of making a commitment to the program. This helps us cover program costs and offer additional rounds in the future. Participants can also choose to donate $50 to help support the participation of someone else.

Question Title

Cost should never be a barrier to participating. If you are not in a position to make a donation, you can simply indicate this below. It will not affect your eligibility for the program.

Question Title

Registration Confirmation

What Happens Next?
CAPA will review your registration. If we need additional information related to your participation in the movement activities or accessibility needs, a member of our team may contact you.

If your registration is confirmed, you will receive a Participant Confirmation Form containing the Peer Support Comfort & Community Agreement, Movement Participation Agreement, and information about the program donation.
( Privacy & Cookie Notice

T