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Community Health Needs Assessment

Women's Wellness Walk Registration

Event Details

Location:  Castonguay Square, downtown Waterville (across from city hall)
Time:         10am-Noon (guided walks at 10:15am, 10:45am, and 11:15am)
Check-in:  Special check-in for those who have pre-registered
Parking:    Downtown Waterville has many options
Dress:         Wear comfortable clothes and walking shoes – we walk rain or shine

Registration







ACTIVITY RELEASE FORM – May 19, 2018
 
Because the Women’s Wellness Walk involves physical activity and possible associated risks, please sign this Activity Release Form for yourself (and your children if applicable) before participating.  This Activity Release Form will be valid for this event on Saturday, May 19, 2018.
 
Before beginning any new program of physical activity, talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.  This is especially important if:
  • Your doctor ever said that you have a heart condition or that you should engage in physical activity only under your doctor’s guidance.
  • You feel pain in your chest when you are physically active.
  • You lose your balance because of dizziness or you ever lose consciousness.
  • You are or may be pregnant.
  • You know of any other reason why you should not be physically active.
 
Begin your physical activity slowly and build up gradually.  If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better and talk with your doctor.
 
Acknowledgement and Release
I understand the information above and have talked with my healthcare provider if I have any questions about participating in Inland Hospital’s Women’s Wellness Walk.  I further understand and acknowledge that some of the injuries which could result from participating in this activity include, but are not limited to the following:  sprains, strains, fractured bones, unconsciousness, head and/or back injuries, etc.  This list is not intended to be inclusive of all injuries that may occur, but rather to inform me of the types of risks inherent to my participation in the above activity, so that I can make a voluntary choice to participate or not participate.
 
In consideration of your allowing me to participate in this event, I agree to assume any and all liability and responsibility for any and all potential risks which may be associated with my attendance and participation in such activity or any incidental activities.  I hereby voluntarily exempt and relieve, on behalf of myself and heirs, executors, administrators and assigns, Inland Hospital and its event partners, sponsors, respective employees, volunteers, agents, and anyone acting on their behalf, from any and all claims of death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of, my participation in this event.  This release and waiver extends to all claims of every kind or nature whatsoever, whether caused in whole or in part by Inland Hospital’s negligence, foreseen or unforeseen, known or unknown.  This waiver, release and discharge includes, but is not limited to, any claims for compensatory damages, consequential damages, reimbursement of medical or other costs, claims for lost income, and any other claims.  I agree not to sue any Inland Hospital for any such claims.  I understand that this Release is intended to RELEASE INLAND HOSPITAL FROM ITS OWN NEGLIGENCE LIABILITY.  I understand that this Release will be construed and interpreted under Maine law.  This Release is intended to be complete, unconditional, and as broad as the law will allow.
 
I acknowledge that I have carefully read and understand this Activity Release Form and that I agree to its terms and conditions.