Wellness Program Waiver and Release

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Wellness Program Waiver and Release

Please read the following, then fill out the form below and indicate you understand and agree to the terms and provide your "signature" by clicking the authorization box. If you have questions, please contact the church office at 817.335.1231.

I, the undersigned, have voluntarily enrolled in one or more of the below physical activity programs, each a wellness program offered through First Presbyterian Church of Fort Worth. I am familiar with the level of physical activities that will be required of me to participate in the program or programs that I choose to participate in.  I recognize that the below programs may involve strenuous physical activity:
Walking Groups
Running Groups
Softball Team
CROP Walk
Tai Chi Classes
Cycling Group Rides
Stretching Classes
Volleyball
Zumba Classes
Yoga Classes

I hereby affirm that my physical condition will allow me to participate in the physical activities that are part of the programs that I choose to participate in. I understand and agree that it is my sole responsibility to determine whether my health and physical condition will allow me to participate in the physical activities of the program, and to choose the physical activities that are appropriate for the current status of my health and physical condition. I understand that I am solely responsible to reconsider the appropriateness of participating in programs in the event of a change in my health and physical condition. I understand and agree that it is my responsibility to ask my doctor whether the physical activities of the program are appropriate for me given my physical condition, before I participate in such activity.  If I have any questions or concerns about whether or not a particular activity is appropriate to my current physical condition, I understand and agree to consult with my doctor on those questions or concerns, before participating in the physical activities of the wellness program. 

I understand and agree that the programs are not medically supervised.  I understand and agree that any exercise activities that are a part of the programs will be led by independent fitness instructors or other program participants, and that First Presbyterian Church of Fort Worth provides such program leadership as a courtesy to me as a voluntary participant.

I understand and agree that any exercise or fitness activity involves a risk of injury, as well as abnormal changes in blood pressure, fainting, and a risk of heart attack, stroke, other serious disability, or death. I hereby accept and assume such risks in order to participate in such physical activities as may occur as part of the programs that I choose to participate in, and I affirm that I have a full understanding of the risks involved.  

In consideration of being permitted to participate in the physical activities of the wellness program, I, the undersigned, hereby release First Presbyterian Church of Fort Worth, and its members, staff, and volunteers, and their successors and assigns, from any and all liability or responsibility to me for illness, bodily injury, or damages of any kind (the “Released Claims”) which may be caused by, or which may result from, directly or indirectly, my participation in the physical activities and programs of First Presbyterian Church of Fort Worth, whether or not the Released Claims result from the negligence or misconduct of any person.

I understand and agree that First Presbyterian Church of Fort Worth may, in its sole discretion and at any time, revoke my enrollment in any wellness program. I also understand and agree that a photocopy, facsimile, or other electronic copy of this signed Wellness Program Waiver and Release shall be as valid as an originally signed copy.

Authorization

Health & Fitness Liability
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