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Si g n a t u re

E x e r cise C on t r act. N a tive Ameri ca n R eh ab i l it a ti o n A sso c i a ti o n of the No r th w est , I n c. Community center exercise contract/waiver Portland NARA of the Northwest. Di a b e tes T r e at m en t & Prev e n t io n T e a m

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Si g n a t u re

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  1. ExerciseContract NativeAmerican RehabilitationAssociationof the Northwest, Inc. Community center exercise contract/waiver Portland NARA of the Northwest DiabetesTreatment&PreventionTeam Matt Dishman Community Center 77NE Knott Portland,OR 97212 The followingisan Exercise Contractfor myuse of the MattDishmanCommunity Center (MDCC)throughpassesissuedfromthe NARADiabetesTreatment& PreventionProgram. Iunderstandthatone“Exercise Pass” willbe issuedtome to usethe pooland/or the fitnessroomat MDCC andthatthe passcannotbe replaced if lostor stolen. Iagree thatIwillbethe onlypersontouse thispassandtosignin atMDCC eachtime Iusethe facility. I agreetoexercisesafelyandwithinmypersonallimitations. IdeemNARAnotliable for anyinjuryor other accidentthat mayoccur overthe courseof my exercise program. IunderstandthatIshouldnotbeginanexercise programunless I ammedicallyable andhave consultedwithmyphysicianeitherinpersonoron thetelephone. I understandthatfundingforthisexerciseprogramat MattDishmanCommunity Center (MDCC)isbased onthe availabilityof grantfunds. TheNARADiabetes Treatment&PreventionProgramreservesthe righttodiscontinue fundingforthis programat anytime. MysignaturebelowindicatesthatIhave readthisExercise Contractthoroughly andagree tocomplywiththese rulesandregulations. PrintName Signature Date

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