CHS Fitness Center Enrollment Form Question Title * 1. First and Last Name Question Title * 2. Birth Date (MM, DD, YYYY) Question Title * 3. Gender Male Female Other Question Title * 4. Campus Location CHS Tulsa CHS Tahlequah Question Title * 5. Campus Affiliation Graduate Student Conners Nursing Program Medical Student Faculty Staff Resident Affiliate (TPD, Medical Examiner's Office, spouse, visiting student, alumni, etc.) Question Title * 6. Campus Wide Identification Number (CWID) Question Title * 7. 16-Digit Card Number (found on the bottom of your card just below your CWID) Question Title * 8. Email Address Question Title * 9. Emergency Contact Information Name Phone Number Question Title * 10. ASSUMPTION OF RISK AND WAIVER OF LIABILITYI am knowingly and voluntarily entering into this Assumption of Risk and Waiver of Liability, as part of my use of the Fitness Center at Oklahoma State University Center for Health Sciences (“OSU-CHS”) and I agree to the terms set forth below.I understand that my use of the Fitness Center is voluntary. My participation in the Fitness Center may include, but is not limited to, physical and recreational activities which require physical exertion and may involve substantial risk of bodily injury, death and other dangers associated with participation in physical and recreational activities. I am fully aware of the risks involved and expressly and voluntarily assume such risks. I understand that I should participate only in those physical and recreational activities for which I have the prerequisite skills, qualifications, and training, and that are appropriate based upon my health. I understand that I should consult a physician if I have any questions about the appropriateness of my use of the Fitness Center.The purpose and effect of this ASSUMPTION OF RISK AND WAIVER OF LIABILITY is to release and insulate OSU-CHS and the Board of Regents for the Oklahoma Agricultural and Mechanical Colleges and their officers, agents, employees, volunteers, representatives, and assigns from and against any claims, suits, or causes of action for injuries, death, damage, loss or expense incurred by me or caused during my use of the Fitness Center, including, but not limited to, those caused or resulting from my negligence or the negligence of any other person, group, or entity, whether intentional or unintentional.I hereby agree that for the sole consideration of my use of the Fitness Center, I knowingly, voluntarily, and expressly waive any and all claims and release and forever discharge OSU-CHS and the Board of Regents for the Oklahoma Agricultural and Mechanical Colleges and their officers, agents, employees, volunteers, representatives and assigns from any and all actions, omissions to act, claims, damages, judgments, demands, rights and causes of action of whatever kind in nature, arising out of all known and unknown, foreseen and unforeseen bodily and personal injuries or damage to property arising out of or related to my voluntarily use of the Fitness Center, including, without limitation, injuries or damages resulting from lack of improper supervision or breach of any statutory or regulatory duty or obligation. I hereby agree that this ASSUMPTION OF RISK AND WAIVER OF LIABILITY shall be binding upon my heirs, executors, administrators and assignees at law and shall be governed by and interpreted in accordance with the laws of the State of Oklahoma.I understand and agree that in the event I or any other party contemplated by this ASSUMPTION OF RISK AND WAIVER OF LIABILITY initiates or attempts to initiate a claim or cause of action of any kind whatsoever, I will indemnify and hold harmless OSU-CHS and the Board of Regents for the Oklahoma Agricultural and Mechanical Colleges and their officers, agents, employees, representatives, and assigns from any liability resulting therefrom, including damages, costs, and related fees.I HAVE CAREFULLY READ THIS ASSUMPTION OF RISK AND WAIVER OF LIABILITY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS ASSUMPTION OF RISK AND WAIVER OF LIABILITY IS A RELEASE OF LIABILITY (INCLUDING BUT NOT LIMITED TO LIABILITY FOR NEGLIGENCE) AND I VOLUNTARILY AGREE TO THE TERMS AND CONDITIONS STATED ABOVE. BY SELECTING YES, I AGREE TO ALL OF THE ABOVE. Yes No Done