Form Center

2. Liberty Parks & Rec is launching a Facebook group where we will offer live stream classes as well as share health and wellness information with the members of the Liberty Community Center.
4. First Name*
5. Last Name*
7. Email Address*
   Please share the email you use for your Facebook log in so we can invite you to the group.
9. Phone Number *
10. Date of Birth*
12. Please check all that apply.*

    Your memberships will be confirmed prior to being invited in the Facebook group. Access to this group is only available to the following wellness carriers:

    1. I am a Liberty Community Center member.
    2. I am a Tivity Health SilverSneakers member.
    3. I am a Tivity Health Prime member.
    4. I am an Active & Fit member.
    5. I am a Silver & Fit member.
    6. I am interested in a Liberty Community Center membership.
14. How important is physical fitness in your life?

    1. Not Important
    2. Somewhat Important
    3. Very Important
    4. Crucial
16. Which classes would you like to see on the Facebook live classes?
18. Participation Waiver
    I am over the age of 18 and acknowledge I have been informed of the need for a physician’s approval for my participation in wellness programming. I acknowledge I have either had a physical examination and been given my physician’s permission to participate, or if I have chosen not to obtain a physician’s permission prior to beginning this program, I acknowledge I am doing so at my own risk.
    
    I understand and am aware that health and wellness programming includes potentially risky activities. I am voluntarily participating in these activities with knowledge of the potential risks. I hereby agree to hold harmless Liberty Parks & Recreation, its respective representatives, executors, agents, and assigns from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected to my participation in any and all wellness programming.
    
    I acknowledge I have thoroughly read this waiver and release and fully understand it is a waiver and release of liability. By signing this document, I am waiving any right I, or my heirs and/or assigns, may have to bring any and all legal actions or assert any and all claims against Liberty Parks & Recreation, its respective representatives, executors, and/or assigns.
    
    * I have read the above information and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
20. Acknowledgement*

    1. I Agree
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22. Submit

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