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

Full Name:	[Name]
Employee ID:
Department/Team:
Position/Job Title:

Wellness Program Details

Name of Program:	[Wellness Workshop]
Date and Time:
Location/Venue:

Program Components

Please check the components you are interested in participating in:

• Fitness Class

• Nutrition Workshop

• Stress Management Session

• Health Screening

Health and Wellness Goals

Share your personal health and wellness goals or areas of interest:

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

Preferred Time:	After Work
Preferred Types:

Dietary Restrictions

Please specify any dietary restrictions or preferences:

Emergency Contact Information

Name:	[Name]
Relationship:
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]

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