Become a participant of The Community for Positive Aging!

Becoming a participant of the Community for Positive Aging (CFPA) is a great way to meet new friends and enjoy a vibrant community with so many classes, programs, and activities to choose from. Register as a participant by completing the online form below.

Although not required for registration, we ask participants to pay an annual registration fee of $20, which helps us to bring our programs to you and fellow participants. If you have questions regarding how to register as a participant, or how to pay the registration fee, please contact us at (503) 288-8303. We hope to see you at the Center soon!

Register

Register Online

Complete our online registration form, which is secure and private. We will never share your information.

If you would like to pay the participant fee, you can do so at the link below.

Participant Registration and Release

General Information

Today's Date

YYYY

Name

First Name

Last Name

Birthdate

YYYY

Phone Number

(###)

###

####

Address

How did you hear about CFPA?

Would you like to receive updates & electronic newsletters via email?

Yes

Already receive

Would you like to receive the monthly newsletter via mail?

Yes

Already receive

Emergency Info

Emergency Contact Name

Relation to Participant

Emergency Contact Phone

(###)

###

####

Do you have any food allergies or medical conditions we should be aware of?

Acknowledgement of Risk & Waiver of Liability

Read this Acknowledgement of Risk and Waiver of Liability carefully and in its entirety. I voluntarily participate in the activity and assume the responsibilities and risks resulting from my participation, including all risk of injury to myself. I agree to comply with all of the rules and conditions of participating in the activity. I will indemnify and hold the Community for Positive Aging and agents (hereafter referred to as CFPA) harmless with respect to any and all claims, injuries, and costs associated with my participation in this activity. It is my express intent that this Acknowledgement of Risk and Waiver of Liability shall bind my spouse, the members of my family and my estate, heirs, administrators, personal representatives and assigns. I further agree to save and hold harmless, indemnify and defend CFPA from any claim by the aforementioned parties arising out of my participation in the activity. PLEASE NOTE: An inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending Community for Positive Aging activities you voluntarily assume all risks related to exposure to COVID-19 and you agree to hold the Community for Positive Aging and all activity partners harmless from any claims related to COVID-19. MEDICAL INFORMATION I herby certify that, with or without accommodations*, I have no health-related reasons or problems that preclude or restrict my participation in the activity. I hereby consent to and understand myself to be solely responsible for the cost of first aid, emergency medical care, and, if necessary, admission to an accredited hospital for executing such care or treatment for injuries that I may sustain. SIGNATURE In signing this Acknowledge of Risk and Waiver of Liability I hereby acknowledge and represent: (a) that I have read this document in its entirety, understand it, and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms and contractual and not mere recital.

Signature

Date

YYYY

Pay Registration Fee

Register by Mail

Print, sign, and send the application (with fees) to us by mail at:

The Community for Positive Aging
1820 NE 40th Ave., Portland, OR 97212

Download Registration Form

Become a participant of The Community for Positive Aging!

Register

Register Online

Register by Mail

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