2017 Membership Form - Team Survivor Northwest
TSNW asks that all new members indicate their areas of interest. Current members - feel free to update your list if you have new interests. Please check all that apply This will allow you to receive up-to-date news and notices from TSNW on the activities in which you plan to participate.
PARTICIPANT INFORMATION: TSNW asks that all New Members fill in the following information. Current Members - feel free to update if there has been a change in your diagnosis. Demographic information may be compiled and anonymously used for grants to broaden additional funding opportunities for programs. The details on your oncologist and place of treatment will be used for outreach purposes. The information will be kept completely confidential. Thank you.
Privacy Statement: Information given to the TSNW office is used only for agency data collection and disbursement of organization information (program e-mails, upcoming events). Program instructors receive contact information in the form of email and phone, for use in case of emergencies (sudden class cancellations due to weather or illness) and receive explicit instructions regarding your privacy. We do not supply personal information to other TSNW members or others who may contact us claiming to have personal ties to you.
Please read both of the following releases. Use your mouse to sign the first as an acknowledgement that you have read the liability release and agree to the terms. Sign the second if you agree to allow us to use your photo in promotional material.
Representations and Liability Releases:
I am aware that participation in fitness programs or events, including TSNW programs and events (a "TSNW" Activity), involves certain risks, including but not limited to the risk of serious bodily or mental injury or death, and the risk of economic loss, arising out of my participation in a TSNW Activity and whether caused by me or by someone else, including TSNW, as defined below. I am aware that TSNW does not manufacture or guarantee the safety of the equipment that may be used during a TSNW activity.
In consideration of my participation in TSNW Activities, by my signature, I acknowledge and confirm that I have read and understood this membership form in its entirety and particularly for the following releases:
Consent to Photo Use and Release:
I hereby consent to the reproduction publication and use of my likeness in any format for promotional purposes or for any other purpose consistent with TSNW's charitable mission, of photographs, movies and videotapes (collectively, "Photos") of me by TSNW. I hereby release TSNW from any liability and/or claims for damages that may arise, now or in the future for the use of any Photos.