Loading...

New Participant Registration

 

 

Informed Consent Waiver & Participant Agreement

Thank you for choosing to become an active participant in the Sports & Fitness Ministry of Northwest Bible church, where we desire to invite people into the unexpected joy of desperate dependence on Jesus.  The information below allows us to know more about you and how to serve you better. All information provided is reserved for the staff of Northwest and will not be shared with any outside sources. We require your full understanding and cooperation in ensuring and maintaining the safety and health of all participants, volunteers and employees by reading, agreeing to, and following the policies and procedures of the program. 

I Agree
I agree to be God-honoring, consistent with Northwest's mission and values and respectful of other participants in my behavior, dress, and music.

  • Behavior: No profanity, taunting, fighting or other unsportsmanlike conduct will be tolerated.
  • Dress: Appropriate athletic attire is required at all time (shirts, shorts, shoes, etc.). Please avoid crude or distasteful logos, slogans, etc. Ministry staff and approved volunteers reserve the right to invite participants to change and/or remove attire that does not align with the set standards. 
  • Music: Music should not contain profanity, crude, or offensive content. Speaker volume should be kept at a level respectful to others in the gym and the surrounding areas.

I Agree
I agree that I can safely participate in a vigorous exercise program.

I Agree
I agree that if I have or develop any health/medical conditions or concerns, I will notify my doctor of my intention to participate in a vigorous exercise program prior to registration and participation.

I Agree
I willingly release Northwest Bible Church, and representatives, from liability and responsibility whatsoever and for any claims or causes of action that I, or assigns, may have for personal injury resulting from participation. I understand there is inherent risk associated with all activities including potentially experiencing heart attack; strain or torn muscles, ligaments and tendons; broken bones; head injury or in extreme cases, death, as a result of participation.

I Agree
I agree that attendance at events or activities includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my attendance; and, I willingly agree to comply with the stated and customary terms and conditions for attendance as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence, I will remove myself from the building and bring such to the attention of the nearest official immediately; and,I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Northwest Bible Church, their officers, officials, agents, and/or employees, other attendees, sponsoring agencies, sponsors, and owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I Agree
I understand that if I fail to keep any of the above statements, the ministry staff has the right to warn, suspend and/or cancel my privilege to participate in the Sports & Fitness Ministry of Northwest Bible Church.

I Agree
I agree that by signing below, I certify that I have read the information and understand that I am in agreement with the above policies set forth by the Sports & Fitness Ministry of Northwest Bible Church.

Today's Date: November 21, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Name: *

Phone Number: *

Relationship to Participant: *
Participant's Activity
Activities
Champion Skills Academy (Terrel Harris)
Yoga
Please select the trainer or ministry partner you are affiliated with
Amanda Stell
Brian Lonergan
Joanna Brown
Kristin Stansky
Regis Johnson
Taylor Stell
Terrel Harris
Justin Lovvorn
If you are a part of an invitational basketball group, please select all that apply.
M/TH AM - Chris Yanniello
Wed AM - Ryan O'Dwyer
T/F AM - JP Schulze & Zach Egbert
Sat AM - Taylor Stell

If you are apart of another group or team not listed above, please list it here
Participant's Background

How did you hear about us? (If you are here with a registered participant, please list their name.) *

What are your fitness goals? *

What are your spiritual goals? *
What is your faith background? *
Spiritual, Christian
Spiritual, Non-Christian
Non-Spiritual
None of the Above

Please describe your current spiritual outlook. *
Are you involved in a local church?*
No
Yes

If yes, what church?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!