PARS Assessment Provider Registration and Set-up Information

PARS Assessment Provider Registration and Set-up Information
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Welcome to Boxers with Parkinson's! Please use this form to provide information we need to set up your account and get to know your locations and coaches. This form supports up to 3 locations and unlimited coaches. If you have a volunteer or non-coach who needs access to the tablet and information, include them with the coaches. If you have more than 3 locations, use this form for the first 3 locations, submit it to BwP, and then use it again for the additional locations.

Be sure to proof read names, email addresses, phone numbers, logins and passwords. You will receive a copy of all the information you provide by email.

Our Executive Director will give you a new member welcome call or Zoom to go over the information and answer your questions. Included in this form are the key terms of membership in BwP. They require you to check the box indicating you understand how things work and what the terms are. If you have questions or are unsure of something, either call/email us before checking the boxes, or, go ahead and check the boxes to continue and take it up with us during the new member welcome call.

Your gym is about to take a huge leap into the future with the assessment app and your Boxers will be part of the largest and longest study of exercise for Parkinson's ever conducted. Welcome to the team!

* Required fields
Name *
E-mail Address *
Provider Name *
Provider Primary Contact (PPC) *
PPC Email *
PPC Phone *
	I'm a Rock Steady Boxing affiliate.
Total active Boxers across all locations.
Type of account: *
	My subscription can be cancelled at any time with no continuing obligation. *
	I understand that the PARS monthly subscription is tiered based on the range of active boxers and anticipated assessments to be performed each month. I have reviewed the subscription pricing page. *
Select your Active Boxer tier: *
Location 1 (L1) Name *
L1 Address *
L1 Coaches. 1 coach / line. Name, Email, Password. *
Location 2 Name
L2 Address
L2 Coaches. 1 coach / line. Name, Login, Password, email. If coach is listed above, just name. Coaches may be associated with more than 1 location.
Location 3 Name
L3 Address
L3 Coaches. 1 coach / line. Name, Login, Password, email. If coach listed above, just name.
Notes, Comments, Questions:
I have read and agree to the Privacy Policy *

We will set up a new member welcome call/Zoom with you soon. Welcome to Boxers with Parkinson's!