Downtown Fitness Center

Downtown Fitness Center

1012B Manatee Ave W, Bradenton, FL 34205
A Liability Waiver must be on file in order to gain access to the fitness center and/or utilize group fitness, personal training, etc. For questions regarding this form, please contact the YourChoice Fitness Center at 941.748.4501 x3979.

Please read the Liability Waiver Terms & Conditions prior to completing this form.

NOTE: If you already have access to the Fitness Center, then you already have a liability waiver on file and DO NOT need to complete this form.
Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Phone Number *
Phone Type *

Cell Home Work
Email *
example@example.com
Employee Status *

Employee Spouse Dependent (19+) Retiree
Employee Agency *

BCC Clerk DOH Elections Florida Courts GAL Housing MSO PAO Port SAO TCO
MSO Location *

Courthouse All Others
Employee ID# *
Do you have an access card for your agency/department? *

Yes No
Access Card # *
Only spouses/dependents who are age 19+ and covered on the YourChoice Health Plan are able to utilize this facility.
Are you a YourChoice Health Plan Member? *

Yes No
Aetna ID (W#) *
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Emergency Contact Relationship (friend, spouse, etc.) *
By signing this form, I acknowledge that I have read the Liability Waiver Terms & Conditions and understand this agreement, and I realize it relates to surrendering and releasing valuable legal rights and do so freely and voluntarily. I also understand that, when exercising at the Fitness Center, I am required to wear a Medical Alert Necklace after office hours when alone and no staff on duty.
Signature *

Clear
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