Employee Wellness Program Participation Slip
Please complete the participation slip below to make your way towards a healthier lifestyle.
Date: [Month Day, Year]
Employee Information
Full Name: | [Name] |
Employee ID: | |
Department/Team: | |
Position/Job Title: | |
Wellness Program Details
Name of Program: | [Wellness Workshop] |
Date and Time: | |
Location/Venue: | |
Program Components
Please check the components you are interested in participating in:
Health and Wellness Goals
Share your personal health and wellness goals or areas of interest:
My goal is to improve my overall fitness and well-being. I aim to incorporate regular exercise, maintain a balanced diet, and manage stress for a healthier lifestyle. |
Preferences
Preferred Time: | After Work |
Preferred Types: | |
Dietary Restrictions
Please specify any dietary restrictions or preferences:
Emergency Contact Information
Name: | [Name] |
Relationship: | |
Phone Number: | |
Consent and Agreement
I, [Name], voluntarily agree to participate in the Employee Wellness Program. I understand that my participation is voluntary, and I agree to the collection of health-related information if applicable. I waive any liability for [Your Company Name] in connection with my participation.
___________________
[Name]
[Month Day, Year]
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