Employee Wellness Liability Waiver & Sign-up Forms 2025

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* 1. Employee ID

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* 2. First Name

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* 3. Last Name

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* 4. Harris Health Email Address

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* 5. Relationship

Employee

Spouse

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* 6. Please Select Your Primary Location

Acres Home Health Center

Administration ACS

Administration Fournace Place

Aldine Health Center

Baytown Health Center

Bear Creek Pedi Clinic

Ben Taub Clinic

Ben Taub Hospital

Casa de Amigos Health Center

CHC - Beaumont Campus

CHC - Central Campus

CHC-Northwest Campus

CHC - Telework

CHP Dental Center

Cleveland E. Odom Health Ctr

Cypress Health Center

Danny Jackson Clinic

E. A. Squatty Lyons Health Cen

El Franco Lee Health Center

Gulfgate Health Center

Harris County Sheriff's Office

Lois J. Moore CNE

Loop Central

Lyndon B. Johnson Hospital

Martin Luther King Health Cent

Monroe Clinic

Northwest Health Center

Outpatient Center

Pasadena - Pedi & Adol Hlth Ct

Psychiatric Unit

Quentin Mease General Hospital

Riverside Dialysis Center

Robindell Same Day Clinic

Sareen Clinic

School Based Clinics - Admin

Settegast Health Center

Smith Clinic

Strawberry Health Center

Sunset Heights Clinic

Telecommute

Thomas Street Health Center

Vallbona Health Center

Warehouse - Sys IT & Logistics

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* 7. Anyone interested in participating in any of the following activities: i.e. group exercise classes (walking, stretch etc.), recreational sports, onsite fitness centers, special events (Field Day, Poker Walks, Runs, Bike Rides etc.) must complete the liability waiver in order to participate. A liability waiver needs to be completed once each calendar year.

Click here to access and read the Harris Health System liability waiver.

By checking this box, I agree to the Harris Health System liability waiver.