• THE ARC OF SAN DIEGO OUR PLACE WELLNESS CENTER REGISTRATION FOR RETURNING PARTICIPANTS

    If you have questions, please contact Justin Umpierre (jumpierre@arc-sd.com) at 619-685-1175, ext. 246.
  • Agreement of Release & Waiver of Liability

  • I hereby agree to the following:

    1. That I am participating in the Our Place Wellness Center during which I will receive information and instruction about exercise and health. I recognize that the Our Place Wellness Center’s classes require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.


    2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Our Place Wellness Center. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in the Our Place Wellness Center.


    3. In consideration of being permitted to participate in the Our Place Wellness Center, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the Our Place Wellness Center.


    4. In further consideration of being permitted to participate in the classes offered by the Our Place Wellness Center, I knowingly, voluntarily and expressly waive any claim I may have against the instructor or The Arc of San Diego for injuries or damages that I may sustain as a result of participating in these classes.


    5. I, my heirs, or legal representative of such forever release, waive, discharge and covenant not to sue The Arc of San Diego and its officers, directors, employees, agents, sponsors, in-kind donors or volunteers and any of its Our
    Place Wellness Center’s instructors for any injury or death caused by their negligence or other acts.


    I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

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  • If participant is under 18 or conserved: - As legal guardian of this participant, I consent to the above terms and conditions:

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  • OUR PLACE WELLNESS CENTER CLASS REGISTRATION

    Participants are registered for Our Place classes on a first come, first served basis. Our Place staff will take every effort to match each participant with their preferred class choices. However, some participants may not be enrolled in all top 3 class choices. All classes are 50 minutes in length. 
  • **Please RANK each class in order of preference. 1 = Most Preferred Class; 9 = Least Preferred Class **

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  • PUBLICITY RELEASE FORM

  • The Arc of San Diego is making a concentrated effort to promote the positive activities and successful work of our staff and consumers. This includes working with the local newspapers, radio,television stations and other media
    publications.


    Throughout the year, there will be opportunities for various participants to be interviewed and/or photographed as well as identified by name and program.

  • I have read and/or fully understand the above "Publicity Release" form. In signing this form, I certify that I am in agreement with its intent and purpose.

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  • **Please note that this consent is updated annually and will be kept on file at The Arc of San Diego. You may revoke consent at any time by notifying The Arc of San Diego staff.

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