You are viewing this page in an application that does not support the display of Hypertext Markup Language (HTML). Please visit http://www.mcbg.org/internal/wellness/Community_Walking_Program/Registration_Form.aspx to view this page in your default Web browser.

Skip to page content.
Site Map
Bookmark and Share

Registration Form

Getting started with The Medical Center Community Walking Program is easy. You can download the registration form and mail it to The Medical Center Health & Wellness Center, or you can complete the online registration below. (Please note that parental signature is required for individuals under the age of 18. Therefore, the registration form must be downloaded and signed by a parent.)

 

Name  
Mailing Address  

City, State, Zip  
Phone  
Email Address (optional)
Check here if you would like to receive periodic email messages from The Medical Center pertaining to walking, fitness and health. You may unsubscribe from this service whenever you choose.
   
Age Category
Complete the following statement: In general, my overall health is...
How many days a week do you currently walk 30 minutes or more?
 
Release of Responsibility

I wish to participate voluntarily in The Medical Center Community Walking Program for the purpose of personal fitness. I understand that it is my personal responsibility to discuss my health status and exercise program with my physician. I hereby release The Medical Center from any liability for any medical event, injury, or accidental occurrence resulting from my participation in the Walking Program.
I verify that I am at least 18 years of age
 
   

 

 

After your registration form is processed, you will receive a mileage card in the mail to begin logging your miles walked.

Anyone with a health risk factor should contact his or her personal physician to make sure it is safe to start a walking program.