HealthyWage Program Liability Waiver and Informed Consent for Associated Bank 

Last modified as of March 12, 2020

By agreeing to this Service Agreement and Liability Waiver, I request to be voluntarily enrolled in a well-being program offered through Associated Banc-Corp, or its affiliated or subsidiary company (“Associated”) entitled “HealthyWage.” I recognize that my participation in this program may involve strenuous physical activity, changes in nutrition, stress management, health and well-being coaching/support, and various other health, weight-loss, and/or fitness related activities that I may select to voluntarily engage in. I am choosing to participate in this program and any affiliated health, well-being, and/or weight loss activities at my own risk.

I affirm that I am in good physical condition and I do not suffer from any known disability or condition which would prevent or limit my participation in this well-being program. I acknowledge and agree that it is prudent to be examined by a physician prior to commencing any well-being and/or exercise program, or initiating a substantial change in the amount of regular physical activity, change in nutrition, or other adjustments that I choose to make. If I choose not to obtain a physician’s consent prior to beginning this program, I am aware that I am doing so at my own risk. I understand that it is my sole responsibility to participate in activities that are appropriate for the current status of my health. If I have any questions or concerns about whether or not a particular activity is appropriate to my current health status, I understand it is my responsibility to ask my doctor if the activity is appropriate before I participate in such activity.

I understand that any exercise or fitness activity involves a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death. I am accepting such risks and I am volunteering to participate with full understanding of the dangers involved. I have also read, understand, and agree to HealthyWage’s Privacy Policy and understand that if I have further questions or concerns, it is my responsibility to contact HealthyWage directly.

I agree that I am fully responsible for my participation, and I hereby waive and release Associated and its officers, agents, employees, representatives or independent contractors and their successors and assigns from any liability, and from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated, arising from my voluntary participation in the well-being program offering entitled “HealthyWage.”

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM AND FULLY UNDERSTAND IT. I UNDERSTAND THAT IT CONTAINS A RELEASE OF LIABILITY. BY AGREEING TO THIS DOCUMENT, I AM WAIVING CERTAIN RIGHTS I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM RELATED TO MY PARTICIPATION IN THE WELL-BEING PROGRAM.