Wellness Adventures Registration

Please fill out the following information and we will contact you within 2-3 business days. For information about (Re)Discover Your Wild Side: Wellness Adventures, please email Dr. Elizabeth Slator, Associate Director, at eslator@rice.edu.

 

General Information 

Name (first and last):  
Date (MM/DD/YYYY):  
Mailing Address:    
Email:  
Age:  
Phone (Cell):   
Phone (Home):  
Emergency Contact Name:  
Emergency Contact Phone Number:  

 

Physical Activity Screening Questions

Regular physical activity is enjoyable and healthy, and for most people safe. However, some individuals may have health-related risks that might require hem to check with their physician before starting an exercise program. Carefully read and answer the following questions. All information will be kept confidential.

(Please answer yes or no to the following questions)

 

Has your physician ever told you that you have a heart condition?
                       

Do you experience chest pain when you are physically active?  
                       
In the past month, have you experienced chest pain without performing physical activity?  
                       
Do you lose balance because of dizziness or do you ever lose consciousness?
                       

Do you ever have a bone/joint problem that could be aggravated by a change in your level of physical activity?  
                       
Is your physician currently prescribing medication for your blood pressure or heart condition?  
                       
Are you a male over the age of 45?  
                       
Are you a female over the age of 55?  
                       
Do you know of any reason why you should not participate in a program of physical activity?  
                       
Please list any major injuries that would interfere with the training and/or trip activities.  

If you answered yes to any of the above questions, it is recommended that you consult with your physician by phone or in person before having a fitness test or participating in a physical activity program.

 

Trip Cost

Price: $400: Recreation Center Member
$450: Non-Member
Open to all Rice Faculty/Staff
Includes: All gear, meals, and local transportation
*Airfare NOT included.  

 

Wellness Adventures Policies and Agreement

 Payment Policy

Total trip cost must be paid in full prior to October 16, 2017. Payments MUST be paid online through the Recreation Center website.

Risk Factor Notice

Participants must be cleared of any risk factors associated with physical activity prior to beginning the program. If a participant is identified as high risk, the participant must provide a signed physician's medical release form stating that the participant has been cleared to engage in physical activity.

Refund Policy

Refunds requests must be submitted in writing (email), and will be assessed on a case by case basis. Cancellations made less than two weeks (14 days) prior to the event will not eligible for a refund, no matter the circumstance. Due to administrative costs, there will be a fee of $40 associated with each refund request. 


                       

 

 

Participation Agreement and Assumption of Risks and Liability

I, , desire to participate in the activities and programs of the Barbara and David Gibbs Recreation and Wellness Center (the "Activities") and, in consideration of being allowed to participate in the Activities and to use the machinery and equipment of the Barbara and David Gibbs Recreation and Wellness Center (the "Facilities"), I do hereby acknowledge and agree as follows.

1. I am fully informed and aware that my participation in the Activities and use of the Facilities involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks.

2. I am in sufficient physical and mental health to participate in the Activities and to use to Facilities. I have medical insurance coverage appropriate for my participation in the Activities and use of the facilities, and I have provided medical insurance and emergency contact information below my signature on this agreement. I understand that Rice University shall not provide any insurance for me in connection with my participation in the Activities or use of the Facilities.

3. I fully and forever release, waive and discharge, and covenant not to sue Rice University (including but not limited to, its trustees, faculty, staff, students, agents, and representatives), from and for any and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to, court costs and attorneys' fees), from any cause whatsoever (including, but not limited to, property damage or loss, bodily injury, illness, or death) directly or indirectly arising in connection with my participation in the Activities or use of the Facilities, whether or not foreseen or contributed to by the negligent acts or omissions of Rice University or others.

4. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements, regarding this subject matter. The Agreement (i) may not be amended, by course of conduct or otherwise, and (ii) may not be assigned, in whole or part, except in writing duly executed by Rice University. This Agreement shall be interpreted and enforced in accordance with the laws of the State of Texas, without regard to any conflicts or choice of law principles, and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect and other provision, and this Agreement shall be construed as if such provision, to the extent of such unenforceability, had not been incorporated herein.

5. I (i) have read and fully understand this Agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs, and legal representatives, (iii) intend that this agreement benefit Rice University, (iv) confirm that I am at least 18 years of age, fully competent, and am entering into this Agreement voluntarily and of my own judgment.