Be Alive Points Program Enrollment-County

Please complete the questions below.
Contact Katie Massman at
You will be contacted by email for all Be Alive information and events.

Name *
Your answer
Email *
Your answer
Do you hold BCBS Medical Insurance through Montgomery County? *
County Department *
Your answer
T-shirt size *
Waiver and Release of Liability: I agree that if I engage in the Be Alive Points Program, I do so at my own risk. I understand and agree that my participation in the Be Alive Points Program is voluntary. On behalf of myself, my heirs, executors, administrators, successors and assigns, I expressly agree to indemnify, release, and hold harmless the Onsite Employee Health and Wellness, CMCEIT, CMCSS, and/or Montgomery County, Tennessee, and their agents/representatives against any and all claims, demands, damages, actions that may arise from injuries or damages sustained by me. By choosing yes below, you have acknowledged that you have carefully read this document in its entirety and fully understand the waiver and release of liability. *
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