Just Move It Oneida - Event Registration Document
In a typical week, how many days do you do at least 30 minutes ofphysical activity?
On a typical day, how many FRUITS & VEGETABLES do you eat? On a typical day, how many cans of REGULAR POP or SWEETENEDFRUIT DRINKS do you drink? (44 oz. = 3-1/2 cans)
On a typical day, how many hours do you watch TV, play VIDEOGAMES, or use the COMPUTER? (Do not include work or school hours)
JMIO Events: T-Shirt Size:
By typing your name in full below, you are acknowledging that you are the signer for this participation agreement. If the person listed in the Participant Information section is a minor, a parent or guardian must sign this document for the individual to participate in the Just Move It Oneida events selected.
Full Name of Signer:
By checking Yes, I am the parent and/or legal guardian of the minor identified in the Participant Information section of this registration.
WAIVER OF RESPONSIBILITY: In consideration of your acceptance of this entry, for myself, heirs, executors, or administrators, I hereby waive and release any and all rights and claims for damage I may have against sponsoringorganizations or representatives for any and all injuries sustained by in any activity, including transportation to and from the site of such activity, related directly or indirectly to my participation of said activity. I hereby give mypermission for the use and reproduction of video footage, photographs or audio recordings. I understand that any use of my image and/or voice will be for the purpose of health promotion.
For questions & comments, contact Hanna Leisgang (920) firstname.lastname@example.org
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Just Move It Oneida - Event Registration Document
Agree & Sign