Take a STEP Toward Better Health!

This walking program is a fun and safe place to take a walk (at your pace), learn health tips from local healthcare professionals, and meet new people. The event is FREE and all are welcome!

Walk Details:

Date: Sat. November 16, 2024 – 10:00 AM

Location: Place Saint Pierre – Route de tete de l’eau, Petion Ville 6140

Registration

Registration / E-Waiver

Chapter Number (Número de Programa)

Please do NOT enter your zip code. Ask your Walk Leader for the 4 or 5 digit chapter number. If you can’t find it, please enter 999. Thank you! Por favor NO ingrese su código postal. Pídale a su líder de caminata el número de capítulo de 4 o 5 dígitos. Si no puede encontrarlo, ingrese 999. ¡Gracias!

Preferred Language

Participant Information

First Name

Last Name

Would you like to receive the free Walk with a Doc newsletter written by Dr. David Sabgir?

Yes

State/Province

Zip/Postal Code

Number of minors attending the walk with you Number of minors attending the walk with you

How did you hear about this walk?

Waiver Acceptance

I agree to the terms and conditions listed below.

Waiver and Release of Liability

Please read each of the following statements carefully.  In this waiver, the term “Just Walk” refers to Just Walk! Inc. (d/b/a Walk with a Doc), its members, directors, trustees, officers, employees, agents, volunteers, sponsors, representatives, and any persons or entities whose property may be used as part of the Just Walk program. Just Walk is a non-competitive program designed to provide general health information and moderate physical exercise in a supportive group environment. I represent that I am in adequate physical condition to participate and that I have consulted my doctor or other health care provider as to any concerns I have regarding my ability to participate safely. I understand that Just Walk cannot guarantee my safety while participating in the program. I understand that participation in the program exposes me to certain risks, including the possibility of serious injury, illness or death, from, but not limited to: (i) traffic, falls and other hazards of walking in different settings, contact with animals, exposure to hazardous weather conditions, (ii) the possibility of walk or weather related injury, and (iii) exposure to communicable diseases (e.g., COVID-19) even if enhanced safety protocols are put into place. I hereby acknowledge and knowingly and voluntarily assume these risks. Medical and health information is given from time to time at Just Walk events. I understand that this information is being given in a public venue for general knowledge and is not intended to replace a personal consultation with my doctor or health care provider. I will consult my doctor or health care provider as to any personal health concerns. I understand that it is my responsibility to protect my property while attending Just Walk events and that Just Walk cannot be responsible for any damage to or loss of such property. I grant permission to Just Walk to use my name, any photographs, motion pictures, recordings, or any other record of my participation in the Just Walk program. I release any rights of privacy and/or compensation that I may have in connection with such use. I have read and carefully understand this waiver. In consideration for my taking part in Just Walk, to the fullest extent permitted by law, I, for myself, my heirs, executors, administrators, successors, and assigns (collectively, “I”), release, waive, and hold harmless Just Walk from any and all liability, claims, demands, damages, costs, actions and causes of action with respect to death, injury, illness, loss of work, or property damage, however caused, arising out of or attributable to my participation in the Just Walk program, including claims of negligence. I covenant not to make or bring any such claim against Just Walk and forever release and discharge Just Walk from liability under such claims. If I violate this covenant, I shall pay all costs and fees, including attorney’s fees, that Just Walk incurs arising out my violation of this covenant.

Información del participante

Primer Nombre

Apellido

Dirección de correo electrónico

Estado/Provincia

Código Postal

¿Cómo se enteró de Walk with a Doc?

Acepto los términos y condiciones que se enumeran a continuación.

Renuncia y liberación de responsabilidad

Por favor lea atentamente cada uno de los siguientes enunciados. Después, haga clic en el botón de abajo para completar la información que sigue. En esta renuncia de responsabilidad, el termino “Just Walk” designa a Just Walk! Inc. (operando bajo el nombre “Walk with a Doc”), sus miembros, directores, miembros del consejo de administracion, representantes, empleados, agentes, voluntarios, patrocinadores y a cualquier persona o entidad cuya propiedad podria usarse como parte del programa Just Walk. Just Walk es un programa no competitivo, disenado para proporcionar informacion general acerca de la salud y ejercicio fisico moderado en grupos de apoyo. Declaro que estoy en un estado fisico adecuado para participar y que he consultado a mi medico o a otro proveedor de asistencia medica acerca de cualquier otro asunto vinculado a mi capacidad de participar al programa en forma segura. Entiendo que Just Walk no puede garantizar mi seguridad durante la asistencia o participacion al programa. Entiendo que mi participacion me expone a ciertos riesgos, incluso la posibilidad de lesiones graves o fallecimiento, debido a factores que incluyen, de forma enunciativa pero no limitativa: 1) el transito, caidas y otros peligros asociados a los paseos en distintos contextos, contacto con animales, exposicion a condiciones climaticas peligrosas, 2) la posibilidad de lesiones o enfermedades asociadas a la caminata o al clima, y exposicion a enfermedades comunicables (ej. COVID-19) a pesar de protocolos de seguridad avanzados. Reconozco y asumo consiente y voluntariamente estos riesgos. De vez en cuando, en los eventos Just Walk se reparte informacion medica y de salud. Entiendo que dicha informacion se reparte en un espacio publico para el conocimiento general y que no pretende reemplazar una consulta personal con mi medico o proveedor de asistencia medica. Consultare a mi medico o proveedor de asistencia medica por cualquier problema personal de salud. Entiendo que es mi responsabilidad proteger mis pertenencias durante la asistencia a los eventos Just Walk y que Just Walk no se hace responsable de cualquier dano o perdida de dicha propiedad.
Doy mi consentimiento para que Just Walk use mi nombre, fotos, peliculas, grabaciones o cualquier otro registro de mi participacion al programa Just Walk. Renuncio a todo derecho a la privacidad y/o compensacion asociada al uso mencionado. He leido atentamente y entiendo esta renuncia de responsabilidad. A efectos de mi participacion al programa Just Walk, yo, en representacion de mi mismo, de mis herederos, administradores, testamentarios, sucesores y representantes asignados, relevo, renuncio y eximo a Just Walk de cualquier responsabilidad, demanda, reclamo, danos, costos, acciones y fundamentos de causa asociados a la muerte, lesion o danos a la propiedad, sin importar como se hayan producido, que surjan de mi participacion al programa Just Walk.

If you are human, leave this field blank.