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Step It Up Waiver

I am participating in the County of Erie Employee Wellness Program ‘Step It Up Erie County’, which is a physical activity/walking program.  I have had the opportunity to review the program and ask questions about it, and understand that participation is entirely voluntary.  I understand that although participating in the program may have a positive effect on my health and well-being; it may also aggravate or adversely affect any medical condition I may have or cause another medical condition(s) to occur.  I have confirmed with my physician that it is appropriate for me to participate in a physical exercise program of this type.  I understand that I am responsible for monitoring my condition and should exercise at a level that is comfortable to me.  I agree to stop exercising if I feel tired or breathless, or experience any type of pain, discomfort or symptom, such as dizziness, chest discomfort, or heart irregularities. I agree to follow all program guidelines and policies.  I understand that the program reserves the right to require any participant to withdraw for reasons of health or safety. By signing below, I hereby waive and release, on behalf of myself and my heirs, executors, and administrators and assigns, my health plan, County of Erie, my employer and its subsidiaries and affiliates, and any other organization participating or involved in providing or promoting the program or any component thereof, including, without limitation, the owners, directors, officers, employees and representatives thereof, with respect to any and all claims, suits, losses, damages, liabilities, judgments, amounts paid in settlement, costs or expenses (including, without limitation, attorneys’ fees and disbursements), and any amounts paid in connection therewith, arising in any manner from my participation in the program, or any resulting illness, injury or condition; and I agree to indemnify, defend and hold harmless any of the foregoing from and against any and all such claims.  This waiver shall survive forever. BY SIGNING BELOW, I HEREBY AFFIRM THAT I WISH TO PARTICIPATE IN THE COUNTY OF ERIE EMPLOYEE WELLNESS PROGRAM ‘Step It Up Erie County’.

Step It Up Photo Release

TO WHOM IT MAY CONCERN: I hereby grant full permission to the CDC, PADOH, Step It Up Erie County and my participating organization, to use, reproduce, publish, distribute, and exhibit my name, picture, portrait, likeness or voice or any or all of them in or in connection with the production of a television tape or film recording, filmstrip, still photograph, or intranet/extranet posting, in any manner for training and other purposes. I understand that if used, portrait shots and other pictures of me will initially be posted on the Step It Up Erie County website and that those pictures may be used by my participating organization as well as at the Erie County Department of Health, Pennsylvania Department of Health, and in CDC’s internal and external written materials, including ultimately on CDC’s Internet site. Without limitation as to time, I hereby waive all rights for compensation in connection with the use of my name, picture, portrait, likeness or voice, or any or all of them, or in connection with said television tape or film recording, filmstrip, still photograph, CDC internal and/or external written materials, or intranet/extranet/internet posting, in whole or in edited form and any use to which the same or any material therein may be put, applied or adapted by the United States Government and others in the health field.