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Employee Wellness Liability Waiver & Sign-up Forms 2025
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1.
Employee ID
(Required.)
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2.
First Name
(Required.)
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3.
Last Name
(Required.)
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4.
Harris Health Email Address
(Required.)
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5.
Relationship
(Required.)
Employee
Spouse
6.
Please Select Your Primary Location
Acres Home Health Center
Administration ACS
Administration Fournace Place
Aldine Health Center
Baytown Health Center
Bear Creek Pedi Clinic
Ben Taub Clinic
Ben Taub Hospital
Casa de Amigos Health Center
Community Health Choice
CHC - Telework
CHP Dental Center
Cleveland E. Odom Health Ctr
Cypress Health Center
Danny Jackson Clinic
E. A. Squatty Lyons Health Cen
El Franco Lee Health Center
Gulfgate Health Center
Harris County Sheriff's Office
Lois J. Moore CNE
Loop Central
Lyndon B. Johnson Hospital
Martin Luther King Health Cent
Monroe Clinic
Northwest Health Center
Outpatient Center
Pasadena - Pedi & Adol Hlth Ct
Psychiatric Unit
Quentin Mease General Hospital
Riverside Dialysis Center
Robindell Same Day Clinic
Sareen Clinic
School Based Clinics - Admin
Settegast Health Center
Smith Clinic
Strawberry Health Center
Sunset Heights Clinic
Telecommute
Thomas Street Health Center
Vallbona Health Center
Warehouse - Sys IT & Logistics
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7.
Anyone interested in participating in any of the following activities: i.e. group exercise classes (walking, stretch etc.), recreational sports, onsite fitness centers, special events (Field Day, Poker Walks, Runs, Bike Rides etc.) must complete the liability waiver in order to participate. A liability waiver needs to be completed once each calendar year.
Click here
to access and read the Harris Health liability waiver.
(Required.)
By checking this box, I agree to the Harris Health liability waiver.
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