WOW Enrollment Form The MPCC “WOW” Concept ... The concept of the Mid-Plains Community College “WOW, Working on
Wellness” program is to provide opportunities for employees to develop and
maintain balanced and healthy lifestyles. In addition, “WOW, Working on
Wellness” will help create an environment within the institution that cultivates
positive communication and healthy relationships, and in turn, will serve as a
model for cultural and educational enrichment within the various communities of
the MPCC area. YES! Sign me up for the MPCC WOW! Working on Wellness Program.
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Please circle T-Shirt Size: SM MED LG XL XXL
RELEASE OF LIABILITY
In consideration of my participation in the Mid-Plains Community
College (MPCC) Working on Wellness (“WOW”) program, I hereby release MPCC, its
officers, agents, employees and Board of Governors, and any other persons
associated with the WOW program, from any and all liability for damages of any
kind, which might occur while I am participating in WOW. I am aware of the risks
of participating, and I understand and agree that my participation is strictly
voluntary, and I freely choose to participate. I understand that MPCC provides
no specific medical coverage for participation in this program, and that I would
be responsible for any costs I incur as a result of participation in the WOW
program.
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Send completed form to:
Wendy Schramm
Mid-Plains Community College
Business Office
1101 Halligan Drive
North Platte, NE 69101
Rev 8/8/07
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Last Update:
01/25/2008 Send Inquiries to: Wellness Team |