Summer STRONG 2024 Registration

* 7. Please read the informed consent below and sign.
INFORMED CONSENT

I declare that I intend to use all or some of the activities, facilities, programs, and services offered by the ACIPCO Wellness Program, referred to as the Wellness Program. I also understand that each person, including myself, has a different capacity for participating in such activities, facilities, programs, and services. I am aware that all activities, services, facilities, and programs offered are educational, recreational, or self-directed in nature. I assume full responsibility, during and after my participation for my choices to use or apply, at my own risk, any portion of the information or instruction I receive.

I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health and to the awareness, care, and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity and service of this Wellness Program brings with it my assumption of those risks of results stemming from this choice of fitness, health, awareness, care, and skill that I possess and use.

I further understand that some of the services, programs, and activities offered by the Wellness Program are sometimes conducted by individuals who may not be licensed, certified, or registered instructors or professionals. I accept the fact that the skills and competencies of some employees and/or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any mental or physical disease or condition by those who are not duly licensed, certified, or registered.

I recognize that by participating in the activities, facilities, programs, and services offered by the Wellness Program, I may experience potential health risks such as intermittent light-headedness, fainting, abnormal blood pressure, chest discomfort, leg cramps, nausea, and other disorders, and that I will assume willfully those risks. I acknowledge my obligation to immediately inform the nearest supervising employee of any pain, discomfort, fatigue, or any other symptoms that I may suffer during and immediately after my participation. I also understand that I may be requested to stop any activity if the supervising employee is not comfortable with my participation in the activity.

I understand that I may ask any questions or request further explanation or information about activities, facilities, programs, and services offered by the Wellness Program at any time, before, during, or after my participation.

I understand that the information obtained during my participation in the Wellness Program may be used for a statistical or scientific purpose, but, in such cases, my identity will not be disclosed. Otherwise, such information will be treated as confidential and will not be released to any person without my expressed written consent or as otherwise permitted by law.

If my participation in the Wellness Program includes the Eagan Center for Wellness, I acknowledge that I have been provided a copy of the Facility Rules and Guidelines, and acknowledge that I have read the rules and guidelines and agree to adhere to them. I understand that I may be asked not to return if I fail to abide by the stated rules and guidelines.

I hereby agree to hold harmless, waive, release, and indemnify American Cast Iron Pipe Company and the Wellness Program, and their employees, agents, officers and directors, from any and all liability and claims connected with my participation in programs and receipt of services offered by the Wellness Program.

By signing below, I declare that I have read, understood, and agree to the contents of this informed consent in its entirety.