Fun With Friends ~ PARTICIPANT REGISTRATION 5/2023

Fun With Friends ~ PARTICIPANT REGISTRATION 5/2023

THIS IS AN OLD FORM. PLEASE FILL THIS FORM OUT INSTEAD: https://form.jotform.com/240386916299167
Fun With Friends monthly content will include:
- Fitness Fun and Movement Activities
- Cooking and Meal Prep activities
- Health Education activities
- Fun With Feelings (group activities for mood health)
Fun With Friends is a monthly health, wellness, and community-building program for adults with disabilities in Snohomish and King Counties. This program is being offered in partnership with Friendship Adventures and is made possible by a Recreation for All grant from Seattle Parks and Recreation.
Come hungry and wear comfy clothes for participating in movement activities!
Fun with Friends will be FREE to all who want to participate between August and November 2023 - courtesy of Seattle Parks and Recreation Grant Funding (Recreation for All Grant).

Session #1: Friday, August 18th - 4:30-7:30 PM
Session #2: Friday, September 22nd - 4:30-7:30 PM
Session #3: Friday, October 27th - 4:30-7:30 PM
Session #4: Friday, November 17th - 4:30-7:30 PM

Location: Northgate Community Center 10510 5th Ave NE, Seattle, WA 98125
For more information contact Hallie at info@insidehealthinstitute.org or text IHI at 425-256-2125

REGISTRATION LINK: https://form.jotform.com/211575926484162Fun

Come hungry and wear comfy clothes for participating in movement activities!
Yes, I would love to donate and doing so does not create a financial hardship for meNo, I would love to donate but to do so would create a financial hardship for meOther
YesNoOther

Virtually OnlyIn Person OnlyBoth Virtually and In-PersonI don't know yetOther
Participant Information
Participant’s Name:*

First NameLast Name
Participant’s Address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Contact Number*
Format (000) 000-000Format: (000) 000-0000.
Main Email for receiving program updates*
Providing your email gives us permission to send you emails and updates about the program.
Any other email you would like to receive videos and Zoom links for weekly virtual program
example@example.com
she/her/hershe/him/histhey/them/theirsOther
malefemaletransgender male/ transmantransgender female / transwomangender queerdecline to answerOther
Birth date*

MonthDayYear
Parent/Guardian Information
Parent/Guardian Name:*
Support Person's name if different than above

First NameLast Name
Parent/Guardian Address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main contact number*
Format (000) 000-000Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Relationship*
Main contact number*
Format (000) 000-000Format: (000) 000-0000.
Second Emergency Contact (optional)

First NameLast Name
Relationship
Main contact number
Format (000) 000-000Format: (000) 000-0000.
Medical Information
Diagnosis*
Special Instructions
Medical Release
Yes, it is safe for me to participateNo, it is not safe for me to participate
Initials*
If you need accommodations to be able to participate, or want to tell us about any medical needs surrounding physical activity, please list them here:
Photographic/Video Release

My signature certifies that:

I consent and authorize the Fun With Friends/Inside Health Institute/Friendship Adventures/Seattle Parks and Recreation and their employees and agents to take photos and/or videos of the above named participant during activities and assigns the right to use and/or other digital reproduction of likeness for publications, whether print, digital, or through electronic publishing via the Internet. I understand that the photographs/likeness may be used in publications, print ads, direct mail piece, electronic media (e.g. video or Internet) or other forms of public outreach promotions.

I release the Fun With Friends/Inside Health Institute/Seattle Parks and Recreation/Friendship Adventures, the photographer/videographer, their offices, employees, agents, and designees from liability for any violation of personal or proprietary rights I may have in connection with such use.

I am 18 years of age or older.
Signature*
Initial here if you DO NOT want participant’s picture to be used for media purposes including publications, print ads, direct mail piece, electronic media (e.g. video or Internet) or other forms of public outreach promotions. *Note: By initialing here the participant is not eligible to participate in many of the Fun With Friends activities which may be photographed or filmed**
2023 RELEASE of LIABILITY
The undersigned who is either
*
Initial* (indicate which applies and initial),

does hereby individually, or in their representative capacity, forever release and discharge Fun With Friends/Inside Health Institute, its officers, directors, partners and agents, from any and all claims, demands, and causes of action, for damages or otherwise, which the participant may have or may sustain by reason of the participant’s participation in the recreational activities sponsored by Fun With Friends/Inside Health Institute identified below. The undersigned, on behalf of him/her/them and on behalf of his/her/their child or ward, agrees to hold Fun With Friends/Inside Health Institute, its partners, officers, employees and volunteers, harmless and free from all liability arising from any activity sponsored by Fun With Friends/Inside Health Institute.

Inside Health Institute is a health and wellness nonprofit that offers affordable mental health counseling, naturopathic medicine visits, and community health education programs. Fun With Friends supports adults with intellectual and developmental disabilities with a series of educational classes in a fun, community-building environment that focused on health, nutrition, and exercise.

Fun With Friends activities may entail risks of eating and exercise, including, but not limited to choking, food allergy reactions or other related injuries. Further, the activities will also include, to some degree or another, use of kitchen tools such as knives, food processors and other kitchen tools, physical activities such as walking, dancing, yoga and weight lifting. These physical activities may result in injury or damage from falls or other physical strain or injury. Other people with developmental disabilities will be participating in the activities, so there is also the risk that confrontations could occur between the participant and others engaged in the activity, which could result in injury. Further, the activity will also entail other additional risks of injury and damage that are reasonably associated with the particular activity identified below.

In consideration for Fun With Friends/Inside Health Institute providing the sponsored activities which the undersigned acknowledges is in the participant’s best interest and would not otherwise be available but for Fun With Friends/Inside Health Institute and their program sponsors, the undersigned, with full knowledge of the risks and benefits associated with the activity and the legal effect of this agreement, executes this release of liability.

Further, the undersigned acknowledges that Fun With Friends/Inside Health Institute is sponsoring the activity in reliance upon the legal effect of this release.
Date*

MonthDayYear
Participant Signature OR Parent/Legal Guardian’s Signature *
Print Name of above Signature*
Should be Empty: