Geneva College

 

 

Individual Sign Up for Walktober


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Individual Registration Form for the Walktober Challenge.
Individual Name: *
If part of a team, please submit this form along with Team Registration Form
Team Name:
Department
I recognize that The Wellness Program of Geneva College is a voluntary program made available to me as an employee. I understand that the Walktober Challenge is a voluntary program, which may involve strenuous physical activity. I further recognize that any injury I may sustain is not the responsibility of The Wellness Program or Geneva College. In addition, The Wellness Program is not included in any of my job responsibilities; therefore, any injury I may experience is not a job-related injury. I assume the risks for any injuries that I may sustain while participating in this program.
Signature:
Date:
Are you currently engaged in a physical activity program?
Yes
No
If yes, what type of activity?
If so, how many minutes per week?