HealthyCity 360 – Participation Waiver

HealthyCity 360 – Participation Waiver

Please read and complete this waiver to participate in HealthyCity 360 community wellness classes.
By submitting this form, I acknowledge and agree to the following:

Voluntary Participation: I am voluntarily participating in free community wellness classes offered by HealthyCity 360, the City of Rincon, and United Way.

Assumption of Risk: I understand that physical activity may involve risks, including injury or illness. I choose to participate at my own risk and agree to move within my personal limits.

Liability Release: I release and hold harmless HealthyCity 360, the City of Rincon, United Way, instructors, staff, volunteers, and partners from any and all claims, liability, or damages arising from my participation, whether caused by negligence or otherwise.

Health Responsibility: I confirm I am physically able to participate and will stop immediately if I feel discomfort, dizziness, or unsafe.
Participant Name*

First NameLast Name
Email Address*
example@example.com
Emergency Contact Name & Phone*
Which class are you attending?*
Yes, I consentNo, I do not consent
Yes, I am 18 or older.Under 18
Parent/Guardian Name (Required for minors)*
Participant Signature*
Date Signed*

MonthDayYear
Date
Should be Empty: