Wayne County YMCA WEIGHT NO MORE Rules & Regulations 1. You must be 18 years of age. 2. You must be a legal U.S. resident 3. You must not be a candidate for a public office and must agree not to become one until one (1) year after the initial publication of standings on January14, 2015. 4. You agree to consult a physician before starting a serious weight loss program. 5. You acknowledge that the “Weight No More” contest is a promotional tool to help motivate you to be healthier and by no means is The Wayne Independent, YMCA or any of the prize sponsors offering health advice. 6. No surgical intervention is permitted. 7. You agree to check in at the Wayne County YMCA, 105 Park St., Honesdale, or their other designated sites, on Thursday, January 8, Friday, January 9, Saturday, January 10 or Sunday, January 11 to be weighed. You agree to check in weekly on Thursday, Friday or Saturday for a weigh-in. You also agree to take part in the mandatory final weigh-in on Thursday, March 26, Friday, March 27 or Saturday, March 28. Contestants are allowed to miss two weekly weigh-ins during the course of the contest. Contestants missing more than two weekly weigh-ins will be subject to disqualification. 8. You agree that The Wayne Independent may publish your name and percentage of weight lost each week in the “Weight No More” standings page. Your weight will not be published, just the percentage of weight lost. 9. One male and one female winner will be determined by calculating the percentage of weight lost. The male and female contestants losing the largest percentage of his/her original weight by the end of the contest will be awarded the grand prize package. In case of a tie, a random drawing will be conducted. 10. Before and after photographs may be taken of contestants and possibly published in the Wayne Independent. Wayne County YMCA WEIGHT NO MORE Consent Form Although the program and instructions are designed to minimize accidents, I understand that the possibility of injury exists. I understand that I may be asked to discontinue my program if I opt to use YMCA equipment and fail to use it according to instructed guidelines, or if I exercise in a manner that may cause injury to myself or others. I also understand I may be asked to delay my program in the case of medical concerns until cleared by a physician. I hereby release and forever discharge the staff, administrators and facilities of the YMCA, The Wayne Independent, contest prize suppliers and contest advertisers from all claims, demands, actions and cause of action of any sort, for injury to my person during my participation in the activities for the program or any injury that follows participation in such activities. With such understanding, I consent to participate in the “Weight No More” challenge. Signature:____________________________________________________________ Witness:_______________________________________________________________ Date:_____________________________________ Wayne County YMCA WEIGHT NO MORE Participation Application Your name (printed): _______________________________________ Address: _______________________________________ ________________________________________ Email Address:_______________________________ Home phone: __________________________________________ Work phone: _________________________________________ Cell phone: ________________________________________ Gender (circle): Shirt Size (Circle): M F S M L XL XXL Weight (to be recorded):_____________________ January 8, 9, 10 or 11 Weight (to be recorded):_____________________ March 26, 27 or 28 I have received and reviewed the Consent Form and Rules & Regulations. I understand and agree to the terms contained on both forms. Sign your name and date: ______________________________________________ Signature _____________ Date