ÿþ<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" lang="en"> <!--FUpUserAgree.html (XHTML 1.0 Verified) ..Consent Form for Enrollment in FitUP program ..Last Change: 30Jan2012[ggh] ..Change Log: 20Feb2004[ggh] Page creation --> <head> <title>FitUP! New User Agreement</title> <meta http-equiv="content-type" content="text/html; charset=ISO-8859-1" /> </head> <body> <div align="right"> <table border="0" cellpadding="3" cellspacing="3"> <tr> <td><b><font color="#008000" size="3"><a href="index.php" target='_top'>FitUP Home</a></font></b></td> <td><b><font color="#008000" size="3"><a href="FUpActivityMain.php" target='_top'>Activity Manager</a></font></b></td> </tr> </table> </div> <center> <table border="0" cellpadding="5"> <!-- Active for Community Wellness Challenge 2 --> <tr align="center"><td><a href="FUpActivityMain.php" target='_top'><img border="2" src="cWC/Images/cWc2012Banner.png" alt="cWc Logo" width="800" height="100" align="bottom"/></a></td></tr> <!-- --> <!-- Not Active for Community Wellness Challenge <tr align="center"><td><a href="FUpActivityMain.php" target='_top'><img border="2" src="images/FUpLogo.jpg" alt="FitUP Logo" width="250" height="40" align="bottom"/></a></td></tr> --> <!-- Active for Community Wellness Challenge --> <tr align="center"><td><h2>Community Wellness Challenge Agreement</h2></td></tr> <!-- --> <!-- Not Active for Community Wellness Challenge <tr align="center"><td><h2>FitUP Agreement</h2></td></tr> --> </table> </center> <table border="1" align="center" width="80%" bgcolor="yellow"> <tr align="justify"><td> <!-- Active for Community Health Challenge --> <p align="justify">Enrolling in the FitUP Program is easy. Enrolling provides you with one username and one password that can be used to access any of the individual healthful programs FitUP has to offer. When enrolling you will be asked some very basic information such as your name and email address or phone number. Your privacy is important to us. Please see our <a href="FUpPrivacy.html">Privacy Statement </a> for additional information. It is important to remember that even though your contact information (email address or phone number) is not required to enroll, if an email address or phone number is not entered, you will not receive program updates and may not qualify for promotional prizes. Just follow these simple steps to get signed up now!</p> <!-- --> <!-- Not Active for Community Health Challenge <p align="justify">Enrolling in the FitUP Program is easy. Enrolling provides you with one username and one password that can be used to access any of the individual healthful programs FitUP has to offer. When enrolling you will be asked some very basic information such as your name and email address or phone number. Your privacy is important to us. Please see our <a href="FUpPrivacy.html">Privacy Statement </a> for additional information. It is important to remember that eventhough your contact information (email address or phone number) is not required to enroll, if an email address or phone number is not entered, you will not qualify for program awards. Just follow these simple steps to get signed up now!</p> --> <ol> <li>Please Read the <b><i>General Consent</i></b> Agreement Carefully.</li> <li>Click the <a href="FUpNewUserInfo.php"><b>Accept</b></a> Button!</li> </ol> <p align="justify">Clicking the <a href="FUpNewUserInfo.php"><b>Accept</b></a> button means that you agree to the terms of the <b>General Consent</b> agreement. After agreeing, you will be asked for information necessary to set up your FitUP account.</p> <ol> <!-- Active for Community Health Challenge --> <li>Once you have enrolled in FitUP you will have access to the various programs FitUP has to offer, including the Healthy Weight Journal 9 Community Wellness Challenge. You could also be asked some questions if you care to participate in voluntary pre and post-program surveys.</li> <!-- --> <!-- Not Active for Community Health Challenge <li>Once you have enrolled in FitUP you will have access to the various programs FitUP has to offer. Some of these programs may require addtional information from you such as a Team or Worksite name if you are participating as part of a group. You could also be asked some questions if you care to participate in voluntary pre and post-program surveys.</li> --> <li>If you do not agree to the terms of the <b>General Consent</b> agreement, click on the "<b>Do Not Accept</b>" button. You will not be registered for FitUP and will not be able to participate in any of the programs.</li> </ol> </td></tr> </table> <center> <h4>General Consent</h4> <!-- Active for Community Health Challenge --> <textarea name="Consent" rows="6" cols="100" readonly="readonly"> Waiver: In accepting this form for myself or the above minor, I release Marquette General Health System, coordinators of the activity, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation including injury, harm, or loss. I grant permission for the use of any information, photo or video related to this event. </textarea> <!-- --> <!-- Not Active for Community Health Challenge <textarea name="Consent" rows="7" cols="80" readonly="readonly"> General Consent: The FitUP.org site provides Upper Peninsula residents with a web based program to improve their health through participation in various programs. The risks involved in participating in these programs are likely to be no greater than those of normal everday living. Please check with your personal physician if you have health problems or have not been physically active. Agreeing to this form indicates willingness to participate in any or all of the FitUP programs. This consent includes permission for all data to be sent to the Marquette County Health Department or the Upper Peninsula Diabetes Outreach Network who will share this data, only after removing any identifying information, with the evaluation staff, and potentially others interested in health program evaluation. Your personal information will be confidential, and all data will be reported as part of larger groups. We may send you a "post" program evaluation to determine how the program has helped people. The purpose of the research is purely for program evaluation. </textarea> --> </center> <br/> <center> <form action="FUpNewUserInfo.php" method="get"> <input type="submit" value="Accept"/> </form> <form action="index.php" method="get"> <input type="submit" value="Do Not Accept"/> </form> </center> </body> </html>