United Way of Brevard, its Affiliate Groups and all Brevard County Municipalities WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

In consideration for participation in the Mayors' Fitness Challenge, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE United Way of Brevard or Health First, any of its affiliate members and any city in Brevard County, from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me while participating  in any physical activity related to the Challenge.

I understand that I should consult my physician before engaging in any physical activity if I have any preexisting condition which could be harmful to me while engaging in physical activity.


Tobacco Use
A note on your privacy - All information collected from you is used by United Way of Brevard and Health First for the purposes of the 2020 Health First Mayors Fitness Challenge and will NOT be disclosed or sold to a third party.

Items marked with an asterisk(*) are required. Please review your responses and make sure you have answered every question with an asterisk (*).

Thank You