Electronic Orientation to IU Daly Fitness Center

Electronic Orientation to IU Daly Fitness Center

Name*

Expected Graduation Date*

Student Email*

Numbers located on back of badge*

(the number that starts with 9)

Please check each box to confirm you understand the information provided.

The fitness center is open 24/7 to student members.*

I Understand

Your access will be granted via your student identification badge within days of submitting your member forms.*

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The Daly gym is now FREE for all medical students.*

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Cancellations require only an email sent to the Fitness Coordinator.*

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All of the strength training and cardiovascular machines have safety features. Please use all safety features when using the equipment.*

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The facility has a safety and security camera and is monitored by S&S.*

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The facility has an emergency panic button. Please use this button if you need immediate assistance from safety & security.*

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The facility is equipped with an AED (automated electronic defibrillator).*

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If you have any questions about the facilities or the equipment: please contact Bryland Sutton at 317-962-8104 or email him at bsutton1@iuhealth.org*

I Understand

If you need in-person guidance or instruction: please contact Bryland Sutton at 317-962-8104 or email him at bsutton1@iuhealth.org*

I Understand

Please read the following information carefully.

As a member of IU’s Daly Fitness Center, you will be expected to

abide by the following terms and conditions. Should you have any questions please feel free to contact Bryland Sutton at 317-962-8104.

By signing below you acknowledge and agree to the above information and the following important conditions:

I agree to abide by the Fitness Center’s rules and regulations.
I acknowledge that participation in physical exercise may present certain inherent risks. These risks include, but are not limited to, injuries to the musculoskeletal and cardiovascular systems. I agree that I will be using the equipment and participating in the Fitness Center activities AT MY OWN RISK.
I certify that I have had a physical within the past twelve (12) months and that my physician has determined that I am physically fit to participate in the Fitness Center membership and activities and that I have not been advised otherwise by a qualified medical person.
I hereby agree, on behalf of myself, my executors, administrators, heirs, next of kin, successors, and assigns, to accept responsibility for my participation and use of Fitness Center activities and equipment use and, thus, waive, release, discharge, indemnify and hold harmless IU, IU Health, their directors, officers, employees, agents, volunteers, and representatives from and against any and all liability or claim of any nature including, but not limited to, claims of property theft or damage, personal injury, death or disability.
I certify that I have completed the ‘electronic orientation’ and feel thoroughly qualified to use all equipment in the Fitness Center facilities.
I agree to contact the Fitness Coordinator with any questions that I may have about the equipment or facilities.
I understand that Fitness Center wellness programs and classes may require fees in addition to the membership fee; I agree to complete necessary paperwork in order to authorize payroll deductions for such additional costs.
I understand that the Fitness Center one-time membership fee is $7 and will be paid by IUSM Medical Student Education.

I have read and understood this agreement and agree to be bound by its terms and conditions:

Please fill out all information below completely to become a member:

Please enter your full name to sign electronically.*

Today's Date*

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