PSC Fitness Center

PSC Fitness Center

2101 47th Terr E, Bradenton, FL 34203
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: The PSC Fitness Center is open to PSC employees only.

For best results please use Chrome, Firefox, or Edge when completing this form.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Phone Type*

CellHomeWork
Email*
example@example.com
Employee ID#*
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relationship (friend, spouse, etc.)*
Acknowledgements:

Liability Waiver Terms & Conditions

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.
Please sign/type your full name to acknowledge:*
Acknowledgement of community risk and responsibility*

I will not enter the Fitness Center if I am experiencing any symptoms of SARS/Covid such as fever, headache, runny nose, cough, or body achesI understand there are masks available upon requestWhile the Fitness Center has taken numerous actions to mitigate risk, I acknowledge there is still inherent risk in participating in indoor group activities
Signature*

Clear
Please read and check all to acknowledge receipt of these benefits for those on the Manatee YourChoice Health Plan, or only check "I am not a MYC Health Plan Member"*

I acknowledge that as a MYC Health Plan member, I receive 5 sessions of Personal Training at no cost per calendar yearI acknowledge that as a MYC Health Plan member, I receive 5 FREE sessions with an RD, LAMP, or Health Coach per calendar yearI am not a MYC Health Plan member
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PSC Fitness Center

Acknowledgements: