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Printed for you from the St. Mary's of Michigan website on 07/31/14
Application
 
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Footsteps for Fitness
Online Application
Printable Walking Log


 
 
 
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bilitation
1015 S. Washington Avenue
Saginaw, MI 48601
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Footsteps for fitness!

Footsteps for Fitness

Walking Club Online Application


Welcome to the St. Mary's of Michigan Footsteps for Fitness walking club sponsored by Fashion Square Mall and Center Courts.

As a member you will receive a log to track your participation. Your cumulative yearly total of fitness days will qualify you to win prizes based on your participation level. There is no cost to join; however, we ask that you provide the following information. By providing your e-mail address, we'll make sure you receive an invitation with the date, topic and location of our monthly "Ask the Expert" presentation. Thank you for your participation. We look forward to serving you.

First Name*
Last Name*
Address*
City/State/Zip//*
Telephone*
Email*
Emergency Contact
Name*
Relationship*
Phone Number*

NOTE: It is always advisable to check with your doctor before beginning any exercise program.

Release Form
By checking the box below and submitting this form, I request membership and participation in the St. Mary's of Michigan Footsteps for Fitness Walking Club (the "Program"). The program encourages me to walk at Saginaw Charter Township's Center Courts, Fashion Square Mall, outdoors, rail trails or treadmills. In consideration for the right to participate in the Program, I hereby agree as follows:
  1. I understand and acknowledge that during my participation in the Program I will receive no formal supervision. I further understand and assume the risks associated with participating in the Program and using the facilities in this setting and under these conditions.
  2. In consideration of being allowed to participate in the Program I do hereby waive, release, and forever discharge Saginaw Charter Township, Fashion Square Mall and St. Mary's of Michigan and its officers, agents, directors, medical staff members, employees, representatives, executors, and all others from any and all responsibility or liability for injuries or damage resulting from my participation in the Program or my use of facilities or for the loss, theft or damage of any article of my personal property which may occur upon the premises. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in the Program.
  3. I understand and am aware that exercise is a potentially hazardous activity and that fitness activities involve risk of injury and even death. I am voluntarily participating in the Program with knowledge of the potential dangers involved and agree to expressly assume and accept any and all risks of injury or death.
  4. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation in the Program, or in any activities of the Program. I have been informed that I should consult with a physician prior to Program participation.
  5. I agree that this Release of Liability shall be binding and of full force and effect upon my heirs, assigns, executors, personal representatives, and guardians, including parents, durable powers of attorney or next of kin.
: I agree with the statements above and am ready to submit my application/registration.

      800 South Washington Avenue | Saginaw, MI 48601-2524 | (989)907-8000 | 1-844-907-8000
©2012 AHIS / St. Mary's of Michigan