Download PCWA INC EXERCISE CLUB FOR PROSTATE CANCER

PROST! Exercise Club 4 Prostate Cancer Inc.
As a new initiative, ‘’Men’s Health@ Complete Physiotherapy’’, is pleased to invite you to attend a new exercise
program, specifically set up for men who have experienced Prostate Cancer. The aim of the program is to establish
community based group exercise sessions, under the guidance of Physiotherapist (Jo Milios) and Exercise Physiologist
(Heath Prentice) within the privacy of a ‘club’ gymnasium. We are pleased to now offer two sites so that more men
can access this world pioneering program. Our pilot program continues at Subiaco Football Club, NIB Stadium,
Leederville, with a new hub at UWA’s Exercise and Performance Centre, Parkway, Entrance #4, Nedlands.
A small fee of $10/session will provide $5/person to the payment of our instructor and the remaining $5/per person is
to be donated to ongoing Prostate Cancer Research at UWA. (PROST!). (Max 15 people/session). Subiaco Football Club
and UWA’s School of Sport Science, Exercise & Health have kindly donated use of their facilities for this specific
program of which we are greatly appreciative. To join, simply fill in the details below with consent from your GP or
treating specialist and return to us.
NAME____________________________________________ D.O.B.: ________________________
ADDRESS: _______________________________________________________________________
PHONE NUMBER (H): ______________ (Mob): ______________________ (W): _______________
EMAIL ADDRESS: __________________________________________________________________
PROSTATE CANCER DIAGNOSIS (date/stage/treatment): __________________________________
________________________________________________________________________________
UROLOGIST/ONCOLOGIST: ____________________________________ Ph: __________________
GP & PRACTICE NAME: _______________________________________ Ph: __________________
SIGNATURE OF TREATING DR: _________________________________ DATE: ________________
SIGNATURE OF PARTICIPANT: _________________________________ DATE: ________________
PREFERRED TIME: (Pls tick  your preferred time & place, 1 or 2 per week as desired, attendance is casual)
LEEDERVILLE:
Tuesday & Thursday
9-10am: _________ or 10-11am: __________
UWA NEDLANDS:
Wednesday & Friday 1:30-2:30pm ______________
NB: No responsibility will be taken for any accident, injury, trauma or unexpected death by Men’s Health Complete
Physiotherapy, PCCA or PCWA in the event of an unexpected event. Attendees enrol at their own risk and with a
personal duty of care to seek medical assistance if problems arise.
THANK YOU! MAY YOU FLY HIGH AGAIN, CAZALY STYLE!!!