Employee Wellness Program Participation Slip
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
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Full Name: |
[Name] |
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Employee ID: |
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Department/Team: |
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Position/Job Title: |
Wellness Program Details
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Name of Program: |
[Wellness Workshop] |
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Date and Time: |
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Location/Venue: |
Program Components
Please check the components you are interested in participating in:
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Fitness Class
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Nutrition Workshop
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Stress Management Session
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Health Screening
Health and Wellness Goals
Share your personal health and wellness goals or areas of interest:
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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
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Preferred Time: |
After Work |
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Preferred Types: |
Dietary Restrictions
Please specify any dietary restrictions or preferences:
Emergency Contact Information
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Name: |
[Name] |
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Relationship: |
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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]
