2021 XL Wellness Challenge Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Registration Form

First and Last Name *

Email address *

Age *

Weight *

T-shirt size *

XXL

3XL

Chapter of Initiation + Year

If you already have a team assembled what are your team members names?

If you have a team assembled, what is "Your Team Name"? PLEASE MAKE SURE THE TEAM NAME IS NO MORE THAN 1-4 WORDS LONG

Consent to Participate and Waiver of Liability: Participants are encouraged to participate in this XL Wellness Challenge (XLWC) and/or physical activity program safely. As with any weight loss and/or physical activity program, there are risks, including but not limited to increased heart stress and the chance of musculoskeletal injuries. In volunteering to participate in this weight loss and/or physical activity opportunity, you agree that, to your knowledge, you have no limiting physical conditions, eating disorder or disability that would prohibit a weight loss and/or physical activity program. A physician’s examination is recommended for all participants with any weight loss and/or physical activity restrictions, heart problems, high blood pressure, chest pain, dizziness, relevant surgeries, diabetes, asthma, epilepsy, arthritis, history of eating disorder or significant injury to any part of the body. If for any reason you are unable or unwilling to engage in these weight loss and/or physical activities, you can withdraw at any time. As an example, you should stop participating immediately if you develop chest pain, or pain in the shoulder, neck, arm or back, or if you experience dizziness or injury or have any concern for any other reason that participating may result in injury.By signing below, you accept full responsibility for your own health and well-being and you acknowledge an understanding that no responsibility is assumed by the organizer(s), support organizations, support personnel or support services. In consideration of my participation in this program, I agree, on behalf of myself, my assigns, executors, and heirs, to release and hold harmless the organizer(s), support organizations, support personnel or support services from any and all liability, damage, or claim of any nature whatsoever arising out of my participation from this program. I understand the organizer(s), support organizations, support personnel or support services will not provide any accident or medical insurance. I have read and understand the terms of this document and agree to all terms and conditions. I am of lawful age and legally competent to sign this waiver and release, and I have signed this document as my own free act. *

I consent to participate and waive liability

Required

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms