Take the Challenge

Use the form below to get your team registered.
If you prefer, paper forms can be downloaded as well.
Deadline is Friday, January 12th.

minimum of 4

 

Consent: I am choosing to voluntarily participate in the New Year, New You Wellness Challenge and I assume the full risk of participation. If I am under a physician’s care for any health condition, I understand that it is my responsibility to get approval to participate in an exercise program from my physician. I understand there are certain risks associated with physical activity including, but not limited to muscle or joint injury, heart attack, stroke or in very rare cases death. I agree that I do not have any health risks that would exclude my participation. I acknowledge that I have read this document in its entirety, or it has been read to me. I consent to participate in, or consent to allow my child to participate in the New Year, New You Wellness Challenge. I also consent to receiving weekly NYNY-related communications from JRMC. Participation is voluntary and I can quit at any time. Submission of my payment serves as my consent.

 

Waiver: By submitting my payment, I do hereby release the above named business, any businesses associated with the New You, New Year Wellness Challenge and Jamestown Regional Medical Center and its employees from all liability, including acts of active or passive negligence, for injury suffered while participating in any phase of the fitness challenge, whether on the premises of the business or while involved in fitness activities off the premises. I do hereby waive and release all rights and claims for damages I might accrue against the aforementioned business and Jamestown Regional Medical Center and any employees of the hospital, their successors, and representatives. I also acknowledge that any injury incurred during voluntary participation of this program is not covered under worker’s compensation.

I acknowledge that each participant on your team recognizes that individual payment serves as consent and agreement to the waiver.
Your NYNY registration will automatically include you in challenge-specific notifications throughout the contest.

Select Your Team Shirt Sizes

See the sizing chart.

Total:

Please verify that the total number of t-shirts match the number of team members. ($Total/10)