The National MS Society offers Wellness programs in the New Jersey Metro area , press option 1,

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1 The National MS Society offers Wellness programs in the New Jersey Metro area. The programs are for people with MS, and classes are adapted for different abilities. Caregivers/Partners are welcome to participate. There are no fees to attend these classes. Registration is required; contact the Society s Navigation Center, , press option 1, OR by moyra.rondon@nmss.org Yoga Warren County, Allamuchy Rutherfurd Hall / School 1686 Route 517 Allamuchy, NJ Wednesdays, 6:00 pm 7:00 pm October 4, 11, 18, 25 Yoga Bergen County, Allendale Crescent Commons Apartment Complex 303 W. Crescent Avenue Allendale, NJ Mondays, 1:00 pm 2:00 pm October 2, 16, 23, 30 November 6, 13, 20, 27 December 4, 11, 18 January 8, 15, 22

2 Yoga Union County, Clark Clark Municipal Building 430 Westfield Avenue Clark, NJ Wednesdays, 11:00 am 12:00 pm October 11, 18, 25 Yoga Monmouth County, Freehold Kershaw Commons 6000 Applewood Drive Freehold, NJ Tuesdays, 4:00 5:00 pm Chair Yoga 5:30 6:30 pm Mat Yoga October 3, 10, 17, 24, 31 November 7, 14, 21, 28 December 5, 12, 19 January 9, 16, 23 Tai Chi Morris County, Denville Church of the Saviour 155 Morris Avenue Denville, NJ Wednesdays, 1:30 pm 2:30 pm October 4, 11, 18, 25

3 Tai Chi Sussex County, Sparta First Presbyterian Church of Sparta 32 Main Street Sparta, NJ Wednesdays from 10:30 am 11:30 am October 4, 25 (no class meeting on 11 and 18 due to room conflict) Aquatic Therapy at the Swim-In program, Bergen County, Tenafly JCC on the Palisades 411 E. Clinton Avenue Tenafly, NJ This program has an application process and waitlist. To be added, contact us Moyra Rondon at or Wednesdays from 1:00 pm 2:30 pm September 13, 2017 May 23, 2018

4 FALL WELLNESS SERIES WAIVER FOR PARTICIPATION For consideration of participation in the Wellness Program(s) to be held October 2017 through January 2018, I, (name), waive and release the National Multiple Sclerosis Society ( Society ), its chapters, directors, officers, administrators, representatives and executors, past and present employees, volunteers, agents, supervisors, participants, all state and local governments, assigns, all sponsors, their representatives and successors and other persons (collectively, the Releasees ), from any and all claims, liabilities, or causes of action arising out of an injury to me and from any and all claims, liabilities, or causes of action arising from my participation in this program. Inherent and Potential Risks I understand that Wellness Programs Yoga, Tai Chi and Aquatics involves physical activity. I understand that physical activity, by its very nature, carries with it certain inherent risks. I assume all risks associated with participating in Wellness Programs relating to the risk of physical activity. I agree to dress myself appropriately as to mitigate risk of physical injury to myself including, but not limited to: wearing shoes appropriate for physical activity involved in Wellness Programs; and dressing in conjunction with the weather. I agree that the Releasees are not responsible for any personal items or property lost or stolen before, during, or after Wellness programs. Medical Evaluation I attest that I am medically and physically able to participate in the Society s Wellness programs. If I experience any doubt as to my ability to successfully and safely participate in and/or complete the Wellness program, I take full responsibility for consulting a physician. I attest that, if I am pregnant, disabled in any way, or have recently suffered an illness,

5 injury, or impairment, I should have or did consult a physician prior to participating in a Wellness program. I consent to emergency medical care and transportation in the event of injury to me as medical professionals may deem appropriate. This Release extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency, including, but not limited to, negligence emergency rescue operations. Photography Release I hereby grant full permission to Society to use, reuse, reproduce, publish, or republish any photographs, motion pictures, recordings, or any other record of my participation in this event, including all Society sponsored pre and post event activities, in any medium now known or hereafter developed, alone or in conjunction with other material, without restriction as to changes or alterations, as well as to use my name, voice, likeness, and/or other indicia of identity, for editorial, educational, promotional, advertising, and commercial purposes, including without limitation in connection with the solicitation of contributions and the furtherance of the corporate objectives of Society. Further, I relinquish all rights, title, and interest in any and all photographs, motion pictures, recordings, or other records of Wellness Programs I may take or capture to Society. You can opt out of the Photo Release by putting an X through the section above.

6 FALL WELLNESS SERIES WAIVER FOR PARTICIPATION I acknowledge and represent that I have carefully read and understand all terms of this Release and Waiver of Liability. Full Name: Signature: Date: Class name/location you are signing up for: Name: Location: Emergency Contact Name: Emergency Contact Number: Emergency Contact Relationship: Return this form signed, prior to attending MS Wellness Programs. Completion and return of this form will lead to registration in above selected class/es. Fax: Moyra.Rondon@nmss.org Mail: New Jersey Metro Chapter 1480 U.S. Highway 9 North, Suite #301 Aspen Corporate Park, Building 1 Woodbridge, NJ 07095

Alzheimer s Arkansas Walks 2017 Individual or Team Registration Form

Alzheimer s Arkansas Walks 2017 Team Registration Form Yes, I/we will form a participate in (please check) Russellville 8/19 Helena 9/9 Hot Springs 9/16 Little Rock 10/7 Conway 10/28 This registration