BIGGEST LOSER 2009

I, the undersigned hereby swear that I am healthy and fit enough to participate in the Healthy South Jordan Biggest Loser 2009 and will in no way hold Healthy South Jordan, it's members, volunteers or any of the sponsors liable for any damages incurred by my willing participation in this contest.  I understand that if I have questions about my fitness to participate, that I need to consult with my doctor and will in no way act on opinions expressed or implied by anyone except for my physician.  I understand that fitness training can be dangerous and can cause injury or even death and I, nor my successors will pursue compensation of any kind for injury or loss incurred as a result of my participation.  ____ (initial)

I understand that it is my sole responsibility to exercise in a manner that is safe for my specific conditions, limitations, and/or impairments.  While the contest administrators may provide helpful tips, plans, recipes and other ideas intended to assist me in my goals, it is up to me and my physician to decide if such courses of action are wise for me to follow.  ____(initial)

I understand that this contest is for entertainment purposes only and prizes and awards from this competition will be distributed at the discretion of the contest administrators. These administrators will have final say on the winners and losers.  No dispute process will be provided.  ____(initial)

I have read and understand the Official Rules of this competition.  ____(initial)

I understand that as part of my participation in this competition, my picture will be taken and may be posted in a public area.  ____(initial)

I understand that it is my responsibility to provide the contest administrators with my current contact information.  Failure to do so may result in forfeiture of prizes and awards and may hamper my ability to receive helpful updates and notices regarding this contest.  ____(initial)

Name:  _______________________________________________________________________________

Address:  _____________________________________________________________________________

Phone:  _____________________________________ Alt Phone:  _______________________________

Email address:__________________________________________________________________________

Birthdate:  __________________________  Height:  ________________  Gender  Male  Female

How many pounds of fat are you planning on losing by April 7?___________________________________

Signature:  _____________________________________________  Date: _________________________

 Costs: $25 for the first person and $10 for each individual afterwards living at the same address.