Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
In consideration of my patronage at the DSC, I hereby waive and release, for me and my heirs, executors and administrators, any and all rights and claims for damages I may have, now and in the future, against the City of Derby, Kansas and it’s representatives, successors and assigns, for any and all injuries suffered by me while participating in any activity sponsored by the DSC, including but not limited to any exercise program, planned trip or activity, or use of exercise equipment. I understand that vigorous physical exercise may aggravate some medical conditions and I have obtained or will obtain clearance from my physician before participating in any such activity. By signing this form I hereby authorize DSC representatives to release my medical information to EMS in the event of a medical emergency.
This field is not part of the form submission.
* indicates a required field