Fitness Center Reservation Form

About You

Format: MM/DD/YYYY

Do you have your COVID-19 Vaccination Card?*

NOTE: If you do not have a COVID-19 Vaccination Card you cannot make a reservation.

Were you ever diagnosed with diabetes by a Doctor?*

Liability Release

I request the use of the San Carlos Apache Healthcare Corporation (SCAHC) Diabetes Program Fitness Center, the equipment, services such as Personal Training, Group exercise and any educational classes, for my personal recreation and for the improvement of my fitness and training skills. I recognize that severe injuries can include, but are no limited to muscle strain, sprains, back injuries, heart attack, paralysis and even death. I realize it is in my best interest to CONSULT A DOCTOR, before engaging in my physical training program and educational program. My interest is solely in my physical training and by own self-improvement. I further Acknowledge that I will observe all of the rules expected of participants of the SCAHC Diabetes Program Fitness Center and what it offers. I HEREBY AND FOREVER RELEASE the SCHAC, agents and employees, and their affiliates from any and all liability for any and all damages and/or injuries suffered by myself, in connection with said use of the SCAHC Diabetes Program Fitness Center facilities or any negligence of the San Carlos Apache tribe/ Diabetes Prevention Program, Employees, Officers and Directors. I understand that my participation is entirely by my own choice and I choose to participate and assume all liabilities. Any activity involving physical exercise creates the possibility of accidental injury, This equipment is intended for the use of participants enrolled in the Diabetes Prevention Program, who have undergone proper orientation and demonstration. Use without proper instruction and supervision is dangerous and should not be undertaken. Before Using, know your limitation and the limitations of the equipment. If in doubt, do not proceed but wait for qualified supervision. As part of my membership agreement, I give my consent to have my weight, blood pressure, fat percentage, body mass, and girth measurements documented at the time of application and monthly thereafter. As a part of our Diabetes Program functions, this data will be collected and used to track the effectiveness of our efforts in preventing/controlling diabetes. All Data will be kept strictly confidential.

Format: MM/DD/YYYY


Fitness Center Reservation Details

Our operations are currently Monday thru Saturday. Format: MM/DD/YYYY

Requested Fitness Center Location*

Note: San Carlos Fitness Center Re-Opens Weds, April 7th.

Preferred Time Slot (SC Fitness Center)*

Time slots are 1 hour long each.

Preferred Time Slot (Bylas Fitness Center)*

Time slots are 1 hour long each.