2018 Membership Registration & Waiver Release

Please fill out the below registration and waiver form.
Your privacy is important to us and your individual answers will not be shared. Answering these questions will help us to better understand what the general needs of the SSBC ChurchFIT Body and Soul Health & Wellness Ministry participants are, in order to better establish appropriate resources and classes for all.

Thank you in advance for wanting to make a difference in your health and wellness.
"The BODY achieves what the MIND believes" (I Cor. 6:19-20)

* 1. Member's Info:

* 2. Are you a returning 2017 ChurchFIT Body and Soul Health & Wellness
member? (If so, input your 2017 membership# below)

* 3. Gender

* 4. Age 12+? (Note: Minors age 12-17 must have guardian sign-up)

* 5. Ethnicity? (check all that apply)

* 6. Please check which Health & Wellness area you would like to participate in 
ChurchFIT Body and Soul (check all that apply)?

* 7. Health & Wellness 2018 Goals: Over the next 6-12 months, which, if any, of the following would be your goal(s) for participating in ChurchFIT Body and Soul
Health & Wellness Program? (check all that apply)?

* 8. Health Conditions: Have you ever been diagnosed by a healthcare provider with any of the following? (check all that apply)

* 9. Consent and Release of Liability (Waiver Form)

In order to participate in the ChurchFIT Body & Soul Health and Wellness Ministry (“the Ministry”) for 2018, I hereby acknowledge the
I HEARBY CERTIFY THAT I am eighteen (18) years or older, that I have read
this release and voluntarily agree to its terms and conditions.
I HEARBY CERTIFY THAT I am eighteen (18) years or older, I am the legal
guardian for the registered participant under age eighteen (18) years, that I
have read this release and voluntarily agree to its terms and conditions.

I HEREBY CERTIFY THAT I request and grant permission to the volunteers,
personnel and organizations participating in the St. Stephen Baptist Church
ChurchFIT Body and Soul Health & Wellness Ministry to perform certain health screenings for me, if requested, as part of the Ministry. I acknowledge and
agree that I understand that these health screenings are to be used solely for
screening purposes, that the results are in no way to be considered conclusive, nor do these assessments constitute medical advice. I further acknowledge and agree that for conclusive measurements and for any medical advice and
treatment, it is my responsibility to contact my own personal health care

Baptist Church, and its affiliates, all Ministry sponsors, Ministry producers,
Ministry team, administrators, officials, contractors, vendors, and organizers,
volunteers, all other persons or entities involved with the Ministry, states, cities, towns, and other governmental bodies and locations in which the Ministry or
portions of the Ministry take place, and the officers, directors, members,
employees, agents, insurers, and representatives of all of the above
(collectively, the "Released Parties"), from any and all claims, causes of action, damages, losses (economic and non-­economic), and liabilities of every kind
(collectively "claims"), for death, personal injury, or property damage, which may arise out of, result from, or relate to my participation in, the Ministry, including
but not limited to any claims for theft, damage to any equipment, negligence,
partial or permanent disability, claims relating to the provision of first aid,
medical care, medical treatment, or medical decisions (at the Ministry site or
elsewhere), and any claims for medical or hospital expenses.

I acknowledge and ASSUME ALL OF THE RISKS of participating in all aspect
of the Ministry in which I decide to participate (collectively, "risks").

Parties for any of the claims that I have waived, released, or discharged herein. I AGREE TO INDEMNIFY and HOLD HARMLESS the Released Parties from
any and all expenses incurred, claims made, or liabilities assessed against
them, including but not limited to attorneys’ fees and litigation expenses, arising out of or resulting from, directly or indirectly, in whole or in part, my participation in the Ministry, the breach or failure to abide by any part of this Release, which cause injury or damage to any other person. I further agree to indemnify and
hold harmless the Released Parties for any expenses incurred, claims made, or liabilities assessed against them, as a result of any insufficiency of legal
capacity or authority to act on behalf of the Participant in the execution of this
I FURTHER GRANT to the Ministry organizers, and their licensees the right, permission, and authority to use my name, voice, picture, or photograph, in any
broadcast, telecast, commercial advertisement, promotion, or other account of
the Ministry (whether for profit or otherwise), and I WAIVE any rights to future
compensation to which I might otherwise have been entitled for such use.

* 10. Are you currently a member of St. Stephen Baptist Church?