AtlantiCare’s HealthyWage Program

PARTICIPANT CONSENT AND WAIVER OF LIABILITY STATEMENT

 

            AtlantiCare Health System, in collaboration with HealthyWage LLC, is offering a community-based wellness initiative in the form of a weight management program (the “HealthyWage Program”).  The 12-week HealthyWage Program includes educational content and contests, focused on nutrition, physical activity and long-term weight loss.  Participants will compete in teams of 5 to win cash prizes.

 

I understand that my participation in the HealthyWage Program is strictly voluntary and that before embarking on any weight loss/weight management or exercise program, I should consult my personal health care provider. I understand that the HealthyWage Program may advocate or involve physical activity such as exercise.  Such physical activity is potentially hazardous activity that may involve certain risks.  By participating in the HealthyWage Program, I assume all associated risks.  It is my responsibility to consult with a physician to determine my ability to participate and to engage in any and all activities associated with the HealthyWage Program.  I am solely responsible for my own safety.

 

I understand that I am responsible for any and all fees incurred by me in connection with my registration and participation in the HealthyWage Program.  I am participating in the HealthyWage Program voluntarily and for my own personal reasons. 

 

In order to participate, HealthyWage will need my name, email address, gender, date of birth, postal code, weight and height.  I understand that HealthyWage may provide limited personally identifiable information to AtlantiCare, including my name and the name of my team members, and/or aggregate my health information data with the data of other participants in the Program and provide such aggregate data to AtlantiCare in order to assist AtlantiCare in monitoring the success of the Program and in improving and/or developing effective health and wellness programs in the future.  By signing this form, I give my permission to AtlantiCare to use my information in the ways described in this Form. 

 

I understand that winners may be required to participate in certain post-contest promotional activities, and hereby give my permission for my photograph, weight loss and/or fitness progress to be used or published by AtlantiCare for publicity purposes and release AtlantiCare from any claims for such use. 

 

I understand that AtlantiCare disclaims any liability for costs, claims, injuries, actions or damages suffered by an individual, no matter what their relationship, as a result of participation in the HealthyWage Program.    Any injuries suffered in conjunction with participation in this program shall not be subject to reimbursement under any workers’ compensation law or any other applicable law.

 

By registering for the HealthyWage challenge through Atlanticare, and certify that I have read and understand the information in this Consent and Waiver of Liability Form. I hereby consent to participate in the HealthyWage wellness initiative on the terms set forth above and agree to absolve and hold harmless AtlantiCare Health System and its affiliated companies of blame for any injury, harm, loss or inconvenience suffered as a result of participation in any of the activities associated with the HealthyWage Program.

 

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