Name*
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Are you:
Status*
Are you eligible to receive Meredith's medical benefits?*
Do you participate in Meredith's medical benefits?*

Verification and Waiver of Liability

The information that is contained in this registration packet, as well as the responses to my disease risk assessment, for participation in WoW!, Meredith’s Faculty-Staff Program, is to be treated as privileged and confidential. It is not to be released or revealed to any person except the faculty-staff Wellness coordinator and those individuals directly related to the program without my written consent. The information obtained, however, may be used for statistical analysis or scientific purposes with my right to privacy retained. I understand that accurate information about my health history and lifestyle is required to establish the most accurate disease risk assessment, and subsequent fitness and wellness programming, for me. I declare that the information provided on the program registration packet and disease risk assessment is true and accurate to the best of my information, knowledge, and belief.

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Liability Release, Waiver, Discharge and Covenant Not To Sue

This is a legally-binding Release made by me to Meredith College.

1. I desire to participate in physical fitness activities made available at or through Meredith College and WoW! Working on Wellness @ Work - Faculty-Staff Wellness program. I fully recognize that there are dangers and risks to which I may be exposed by participating in such activities, including travel to and from the activity, which dangers and risks could result in personal injury, property damage and even death. I understand that these activities are sometimes conducted without supervision or instruction, and that, in limited circumstances certain activities are supervised or taught by instructors that may or may not be employees or agents of Meredith College. I understand that the activities may be offered in the physical location at Meredith College or offered online by videos, television, podcasts, apps or other digital media or platforms. All of such offerings, either physical or online, shall be considered “activities”. The following is a description and example of specific, significant, non-obvious dangers and risks associated with participation: muscle strains, joint sprains, soreness, bodily harm such as back, neck and joint injuries, heart failure or other related conditions. I understand that Meredith college does not require me to participate in this activity, but I want to do so despite the possible dangers and risks and despite this release. I acknowledge that I have attended, or had the opportunity to attend, an orientation training session regarding the activities made available through the WoW! faculty/staff program as well as the fitness center and/or the equipment and facilities used in or related to such exercise program. I further acknowledge that I have read a written statement of the group exercise and fitness center policies, and completed a health and fitness disclosure form identifying my health and fitness capabilities. I certify that I am medically sound and physically fit to participate in activities offered through the WoW! program.

 2. In consideration of and in return for the services, facilities and other assistance provided to me by Meredith college in this activity, I therefore agree to assume and take on myself all of the risks and responsibilities in any way associated with this program and its activities, and I release Meredith College (and its governing board, officers, employees and agents) from any and all liability, claims and actions that may arise from injury or harm to me, from death or damage to my property in connection with this program. I understand that this release covers liabilities, claims and actions caused entirely or in part by any acts or failures of Meredith College (or its governing board, officers, employees and agents) including but not limited to negligence, mistake or failure to supervise by Meredith College.

 3. I further authorize Meredith College to seek emergency medical treatment in connection with my participation in the activity and I acknowledge and agree that Meredith College will assume responsibility for, and shall be released from any claim or liability relating to, any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.

 4. I recognize that this Release means I am giving up, among other things, rights to sue Meredith College, its governing board, officers, employees and agents for injuries, damages or losses I may incur. I also understand that this release binds my heirs, executors, administrators and assigns, as well as myself.

 5. I have read this entire release; I fully understand it and I agree to be legally bound by it. No oral representation, statements or inducements have been made with regard to this release or the activity or program.

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Contact Information
Mary Johnson
110 Carroll Hall
(919) 760-8139
mbjohnson@meredith.edu

Campus Wellness List
campuswellness@meredith.edu