FitWell Risk Waiver

This form below must be filled out for each individual FitWell Class a student is enrolled in, every semester. Failure to fill this form out completely and correctly will negatively impact your ability to participate in the course activities and your grade. This is an official form between you and the University. It must be filled out correctly, so please double-check the instructor name, section and course number.

After you submit, you may want to screenshot your Confirmation Page for your instructor. Your instructor may ask for this to confirm that you filled out your form correctly on the first day of class activities.

You can not participate in course activities until this form is completed correctly.

If you don’t know your Course Number or Section/Lecture Number, you can find it in the top left corner of your Canvas Class page, in your course syllabus, or in PAWS.

This form is a basic web-based form so if the form doesn’t work for you, please try another browser or different device. (No UWM login is required so it can be done on most devices and most browsers.)

Semester/Class Starts(Required)

Please choose the Semester and when your class starts from the drop down.

Class Title(Required)

Please make sure to select the correct information and fill this entire form correctly. Failure to complete the form correctly will result in not being able to participate in the class until the form is re-submitted with accurate information. You can find all the details needed in PAWS or Canvas.

Course Number(Required)

In Canvas when you have the class page opened on a computer, it would be the first set of numbers before the dash in the top left corner. Failure to complete the form correctly will result in not being able to participate in the class until the form is re-submitted with accurate information.

Lecture/Section Number(Required)

Please enter a number from 100 to 600.

You can find your Section/Lecture Number in Canvas or PAWS (it’s the second set of three numbers beside the course number). In Canvas, it is located in the top left corner in blue (or top center of the page in white) on your specific class page. *Please enter the correct 3 digit number only. This is not the five digit Class Number. This also doesn’t include the Course number.* Failure to complete the form correctly will result in not being able to participate in the class until the form is re-submitted with accurate information.

Instructor Name(Required)

Please double check your instructors name is the name of the primary instructor.

Participant's Name(Required)

First Last

Participant's UWM Email(Required)

Please enter your @uwm.edu email address. No other email addresses will be accepted.

By signing I agree to the statements below.

I [name entered], desire to participate voluntarily in Sport & Recreation Class [class name entered] conducted, directed, supervised or sponsored by the Board of Regents of the University of Wisconsin System, operating as the University of Wisconsin–Milwaukee Zilber College of Public Health Sport & Recreation Department (hereinafter referred to as UWM), located at Enderis Hall, 2400 E Hartford Ave. These activities will primarily occur at the following locations: Engelmann Gym, 2033 E. Hartford Ave.; Brown Deer Golf Course, 7625 N. Range Line Rd..; Bradford Beach, 2400 N. Lincoln Memorial Dr.; Gordon Park, 2828 N. Humboldt Blvd; Zao Mke Church, 2319 E Kenwood Blvd.; Klotsche Center, 3409 N. Downer Ave.; Lake Park Tennis Courts, 3233 E. Kenwood Blvd.; Milwaukee Turners, Inc., 1034 Vel R. Phillips Ave.; Pavilion, 3409 N. Downer Ave.; Plymouth Church, 2717 E. Hampshire Ave.; Pura Vida BJJ & MMA, 4125 N. Richards St.; Union Recreation Center, 2200 E. Kenwood Blvd.; Wil-O-Way Underwood, 10602 Underwood Pkwy, Wauwatosa, WI 53226.; Devil’s Lake State Park; Boulders Climbing Gym in Madison; and some activities will be done at your place of residence.

I UNDERSTAND THAT I AM BEING ASKED TO READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. I UNDERSTAND THAT IF I WISH TO DISCUSS OR ALTER THE TERMS CONTAINED IN THIS AGREEMENT, I MAY CONTACT PROGRAM SUPERVISOR AT TELEPHONE NUMBER 414-227-3123 OR VIA EMAIL AT chsout@uwm.edu.

Authorization Method(Required)

Authorize by providing your signature

Authorize by typing your full name

Participant's Full Name(Required)

Parent or Guardian's Full Name (If Participant is under 18)

*Only Required if Participant is Under 18

Signature of Participant(Required)

Signature of Parent or Guardian (If Participant is under 18)

*Only Required if Participant is Under 18

Date(Required)

Authorization Method – Assumption of Risks(Required)

Authorize by providing your signature

Authorize by typing your full name

Participant's Full Name – Assumption of Risks(Required)

Parent or Guardian's Full Name (If Participant is under 18)

*Only Required if Participant is Under 18

Signature of Participant- Assumption of Risks(Required)

Signature of Parent or Guardian (If Participant is under 18)

*Only Required if Participant is Under 18

Date(Required)

Authorization Method – Hold Harmless, Indemnity and Release(Required)

Authorize by providing your signature

Authorize by typing your full name

Participant's Full Name – Hold Harmless, Indemnity and Release(Required)

Parent or Guardian's Full Name (If Participant is under 18)

*Only Required if Participant is Under 18

Signature of Participant- Hold Harmless, Indemnity and Release(Required)

Signature of Parent or Guardian (If Participant is under 18)

*Only Required if Participant is Under 18

Date(Required)

This field is for validation purposes and should be left unchanged.