Family Enrollment Form

I, the undersigned hereby release Onvida Health; it’s instructors, leaders, supervisors, staff & volunteers of any liability that may incur while participating in the Healthy Kids program. I further understand that participating in physical activity and consuming foods may cause harm or personal injury. I personally assume all foregoing risks and accept personal responsibility for any and all claims and/or causes of actions following any such personal injury. In the case of personal injury and/or harm, I will seek medical attention from my personal physician.

Onvida Health reserves the right to photograph facilities, activities and program participants for potential future use. All photos will remain the property of Onvida and may be used for publicity or promotion purposes.

For the consideration stated herein, I hereby assign and grant for Onvida Health, their clients, customers, agents, licensees and assigns, free and unlimited right and permission to copyright and/or publish photographic portraits or pictures of me and my child(ren) in which I may be included in whole or in part or composite or reproductions thereof in color or otherwise made through any media at their studios or elsewhere for art, advertising, trade or similar lawful purpose whatsoever.

I hereby waive my right to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith.

I hereby release and discharge Onvida Health, its successors and all persons under its permission or authority or those for whom it is acting from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form that may occur or be produced in the taking of said picture or in any processing tending toward the completion of the finished product.

The questions in this survey are pulled from the Family Nutrition and Physical Activity survey, a health screening tool developed by researchers at Iowa State University in collaboration with the Academy of Nutrition and Dietetics.

Please fill out the survey honestly and completely. This is used to learn more about you so that we can better serve you. Your answers are anonymous, so please do not write your name on this survey. Thank you for participating in Healthy Kids.

Copy this link onto a new tab to fill the form: https://forms.gle/F8CzQEBq6bgYVRnb9