Participant Notice: Participation in the FALL into Fitness program is voluntary. Please consult your physician or healthcare provider before beginning any new exercise program. All participants will be required to review and sign the Assumption of Risk and Hold Harmless Waiver prior to participating. Participants must be 18 years old or older and a Mount Olive Resident. Please note that if the NO Harm form is not signed, you will be unable to participate.

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1. Registrant name:

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3. Phone:

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4. Address:

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5. Age

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6. Have you read and signed the TOWNSHIP OF MOUNT OLIVE
FALL INTO HEALTH FITNESS PROGRAM WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT

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