Gamecocks on the Move (GOTM)

Summer and Fall 2012 Registration Form
Gamecocks on the Move Program Registration

Campus Wellness is excited that you are joining our walking and running club – Gamecocks on the Move! This club will help you be more physically active, meet other USC faculty and staff members, and achieve your 5K race goals. This semester, we will participate in the Palmetto Health Race for Life 5K as a group. Training for this race will start 10 weeks before the race on July 30^th. Whether you have done a 5K before or are just trying to finish your first 5K race, this club will provide you with the resources and support to cross that finish line!

Your Name

USC E-mail Address:

I am:

Department/Office:

Gender:

Race/Ethnicity:

Are you a USC Family Fund donor?

USC Phone Number:

What are your training preferences for the 5K race?

Availability for training during the 10 weeks?

If you selected other:

As a member of the club, you will receive a directory of the availability of other members in the club. This directory will be updated weekly and will help you find social support to help you with your training goals. Would you be willing to have your contact information and availability listed in a GOTM directory? Only your name, office number, email address, run/walk training preferences, and training availability will be posted in this directory.

To help us assess your experience with 5K races, please answer the following questions:

Have you ever ran or walked a 5K in the past?

If yes, how many races have you participated in?

Please indicate your goals for participating in the club and 5K race? (Examples: finish faster or increase speed, increase endurance, lose weight, finish a 5K for the first time, etc)

How often do you participate in moderate or vigorous physical activities during the week? (For health benefits, experts recommend: 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking, water aerobics, riding a bike on level ground or with few hills, pushing a lawn mower, cleaning the house) every week or 1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running, swimming laps, riding a bike fast or on hills, playing basketball).

How motivated are you to increase your physical activity at this time?

In keeping with our educational mission, Campus Wellness strongly recommends that before you begin any physical activity program whether self-directed or under the guidance of Campus Wellness staff as a participant in the Gamecocks on the Move: Running and Walking Club, that you speak with and seek guidance from a medical physician to maximize your safety.

I understand that it is beneficial for me, and Campus Wellness recommends, speaking with and seeking guidance from a physician prior to beginning a physical activity program or before making changes to my current level of physical activity - self directed or otherwise. {THIS BOX HAS TO BE CHECKED BEFORE SUBMISSION.}

I acknowledge that my participation in the Gamecocks on the Move Club is voluntary, and I assume full responsibility for any resulting injuries and damages. {THIS BOX HAS TO BE CHECKED BEFORE SUBMISSION.}