PSC Fitness Center

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 all Manatee County Government Employees. Spouses and Dependents 18+ on the Manatee YourChoice Health Plan are eligible, however must be accompanied by the Employee. Hours: 6:00am - 8:00pm

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

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Employment Status:*

EmployeeSpouse on YourChoice Health PlanDependent 18+ on YourChoice Health Plan

Employee Name*

First NameLast Name

Employee Phone Number*

Area CodePhone Number

Employee ID#*

Employee Agency*

BCC (Employees with a Manatee County Government Badge)Manatee Sheriff's OfficeBradenton Police Dept.Palmetto Police Dept.

Employee Email*

example@example.com

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.

I ackowledge this is a perk of my employment and misuse of this privilege will result in termination of fitness center access.

Please sign/type your full name to acknowledge:*

Acknowledgement of community risk and responsibility*

While the Fitness Center has taken numerous actions to mitigate risk, I acknowledge there is still inherent risk in participating in indoor group activities

Signature*

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