OLOSE - Oak Brook Park District
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1 8 Oak Brook
Pa r k D i s t r i
20 S E L O S E
TO
CH O O
Sponsored by:
January 8 - March 2
INFORMATION
PACKET
WELCOME to the 2018 Choose to Lose program!
Individuals age 65+ will compete in weekly challenges and weigh-ins to lose
pounds and earn prizes. The top 2 overall individuals that have the largest
percentage of weight loss (by using percentage of weight loss, individuals
that weigh less are not at a disadvantage) will win a 1 year membership to
the Oak Brook Park District.
Individuals will receive:
• One-hour personal training session
• Oak Brook Park District Choose to Lose apparel
• Body composition analysisRegistration Procedures
YOU ARE REQUIRED TO READ THIS ENTIRE PACKET PRIOR TO REGISTERING.
•Individuals must sign up together by Friday, January 5, 2018.
NO LATE REGISTRATION WILL BE ACCEPTED.
•Cost: $45 per person.
•Sign-up by filling out a program registration form with Code 8006 and payment. Forms are available in the
administration office, the front desk at the Family Recreation Center, or online at www.obparks.org.
•Return the completed form to the Administration Office, or to the drop box located outside the Office.
Forms may also be submitted via fax or online.
•Once registration is received, you will receive a confirmation e-mail from Mike Delgado, Program Director,
with further details about the program.
General Information
•Choose to Lose begins the week of January 8 and ends on March 2, 2018. You will sign up for your weekly weigh-in/
challenge when you have received a registration confirmation email.
•Choose to Lose participants will have weekly weigh-ins, weekly fitness challenges, and homework challenges. (You
will reserve one 30-minute block of time for each week to come in to complete weigh-ins and challenges.)
•The top 3 individuals of each weekly fitness challenge will receive pounds deducted from their total weight.
• Weigh-ins and challenges begin with Week 1.
• Individuals that complete the homework challenges will receive pounds deducted from their total team weight.
•Winners are determined by percentage of weight loss so individuals that weigh less are not at a disadvantage.
•The two individuals that have the largest percentage of weight loss at the end of the program will
receive prize packages. This is calculated by taking the beginning weight, subtracting the final weight, dividing by
the beginning weight, and multiplying by 100.
•All program events (weigh-ins and challenges) must be completed during weekdays.
There is no weekend availability.
•Each individual will receive: Choose to Lose apparel; a 60-minute personal training session to be
used prior to the completion of the program; and two body composition assessments.
•All participants will receive the member rate on annual memberships and personal training packages
of 2, 5, or 10 sessions during the duration of the program.
-2-Weekly Weigh-Ins
•Individuals will weigh-in weekly. Weekly weigh-ins occur immediately before the weekly
challenge. (You will reserve one 30-minute block of time to complete the challenge & weigh-in.)
•An electronic impedance scale will be utilized for all weigh-ins. Individuals with a pacemaker cannot
be weighed in. All individuals weighing in will be required to remove their shoes and socks. Two
pounds will be removed for clothes at each weigh-in.
•Weekly weigh-in times must be set up with the program director via e-mail in advance. (You will reserve a
30-minute time slot for the weigh-in/challenge).
Weekly Challenges
•Each week individuals will undergo a “Weekly Fitness Challenge” at the Oak Brook Park District. This
will be an opportunity for individuals to earn pounds deducted from their total weight. Challenges will be
scheduled in thirty minute blocks with weigh-ins.
•Weekly challenge times must be set up with the program director via e-mail in advance. (You will reserve a
30-minute time slot for the weigh-in/challenge).
•The top three individuals from each weekly challenge will have the following pounds deducted from their
total team weight loss:
FIRST PLACE SECOND PLACE
3 lbs 2 lbs
THIRD PLACE
1 lb
•Weekly challenge videos will be posted on the Choose to Lose web page every Friday afternoon allowing you
time to prepare for the challenge.
(more information on back)
-3-Homework Challenges
Homework Challenges will be issued weekly during the 8 week period. If you complete the challenge, you will
be rewarded with pounds deducted from your total weight. Homework challenges will be exercise and nutrition
challenges designed to guide participants towards their health and fitness goals.
•Homework challenge information will be posted on the Choose to Lose web page. Individuals that complete the
homework challenge will receive pounds deducted from their total weight loss.
IMPORTANT DATES
•Week 1: Jan. 8-Jan. 12 •Week 5: Feb. 5-Feb. 9
Initial Weigh-In/Challenge #1 Challenge #5/ Weigh-In
•Week 2: Jan. 15-Jan. 19 •Week 6: Feb. 12-Feb. 16
Challenge #2/ Weigh-In Challenge #6/ Weigh-In
•Week 3: Jan. 22-Jan. 26 •Week 7: Feb. 19-Feb. 23
Challenge #3/ Weigh-In Challenge #7/Weigh-In
•Week 4: Jan. 29-Feb. 2 •Week 8: Feb. 26-Mar. 2
Challenge #4/ Weigh-In Final Challenge and Final Weigh-In
Choose to Lose Web Page
•The Choose to Lose web page will be updated weekly with challenge information, results & standings (each
person’s weight is confidential).
Program Director
•Michael Delgado, Fitness Supervisor, Certified Personal Trainer
For more information, contact Michael Delgado at (630) 645-9542 or mdelgado@obparks.org.
1450 Forest Gate Road
Oak Brook, IL 60523
phone: (630) 990-4233
fax: (630) 990-3492
www.obp a r ks .or g
-4-Oak Brook Park District Registration Form
Administ ration O f f ice | 1450 Fore st Gate Road | (630) 6 45 -959 0 | re gist ration@o bpark s.or g
Tennis Center | 130 0 Fore st Gate Road | (630) 99 0 - 4660 | tennis@o bpark s.or g
Separate households require separate registration forms.
*Please indicate if a registrant has any dietary needs or requires any special accommodation or assistance for
enjoyment of programs. Allow two weeks notice for accommodation. ____________________________________________
_________________________________________________________________________________________________________
Part 1 Primary Contact and Participant Information (Oak Brook Residency verification required)
Head of Household (Full Name): ______________________________________________________Birth date (required): _______________________
Address__________________________________________________________________________________________________________________
City____________________________________________________ State_______________________ Zip____________________________________
Cell Phone #_____________________________________________ Home Phone #_____________________________________________________
Email___________________________________________________ ☐ Check here if you are a Corporate Resident. (Letter REQUIRED)
BIRTH DATE
PARTICIPANT’S NAME GENDER PROGRAM NAME CODE FEE
MM/DD/YY
$
$
$
$
$
$
$
$
$
Part 2 Payment Information
Credit Card (If paying by credit card) ☐ Visa ☐ Mastercard ☐ Discover ☐ American Express Payment Amount: $_____________
Credit Card #: _______________________________________________________ Expiration Date: /
Name of Cardholder:_________________________________ Authorized Signature: _______________________________________
Must have signature to be processed
By execution of this authorization, the undersigned herby gives the Oak Brook Park District permission to charge the credit card identified here-in for all
charges accrued at the Oak Brook Park District for all listed Authorized Individuals. Patrons are responsible to notify the OBPD of any changes of address,
credit card or expiration date information.
Keep my card on file. Signature of Cardholder:_________________________________
MY CHECK IS ENCLOSED. Please make checks payable to Oak Brook Park District. A $25 fee is charged for all returned checks.
I have read the program waiver stated on the back and understand that my signature is required in order to participate in any program.
________________________________________________________________________________________________________________________
Participant/Parent/Guardian Signature Date
Signature MUST be included for Registration Form to be processed.Oak Brook Park District Registration Form
5 Easy Ways to Register!
DROP-OFF/WALK-IN MAIL-IN FAX ONLINE EMAIL
Drop off a completed Send your completed Fax your completed To register online Email your completed
registration form with registration form and registration form and visit or web site at registration form as an
payment during regular payment to (check, credit card payment www.obparks.org. attachment to
business hours at the Family money order, Visa, Discover, information to (Visa, Discover, registration@obparks.org
Recreation Center Administrative American Express, American Express, or tennis@obparks.org.
Office or the Tennis Center. or Mastercard only. or Mastercard only.
Cash NOT accepted.) No other form of payment
For convenient after-hours will be accepted.)
registration, a drop box is located Oak Brook Park District Sorry, no telephone registration
outside the Administrative Office. Administrative Office Recreation Programs/Aquatics is accepted.
1450 Forest Gate Rd. (630) 990-8379
Oak Brook, IL 60523
Tennis Programs
Oak Brook Park District (630) 990-4818
Tennis Center MARK YOUR CALENDAR!
1300 Forest Gate Rd. A representative from the Park District will contact you in case
Oak Brook, IL 60523 there is a wait list for the program for which you registered.
GENERAL INFORMATION
1. Carefully complete the Oak Brook Park District registration WAIVER AND RELEASE OF ALL CLAIMS SWIM PROGRAM WAIVER & RELEASE OF ALL CLAIMS
form. Enter the code number in the code column of the Please read this form carefully and be aware in registering
registration form. (Example code number: 17756) Use the form yourself or your minor child(ren)/ward(s) for participation in IMPORTANT INFORMATION
for all free and paid Park District programs. Please print and make the above program(s)—you will be waiving and releasing all The Oak Brook Park District is committed to conducting its
sure all information is correct. claims for injuries you or your minor child(ren)/ward(s) might recreation programs and activities in a safe manner and holds
2. THE WAIVER FORM MUST BE SIGNED FOR THE sustain arising out of your participation in the program(s) you the safety of participants in high regard. The District continually
REGISTRATION FORM TO BE PROCESSED. have registered for. strives to reduce such risks and insists that all participants
3. Add up the fees and write the total amount in the appropriate follow safety rules and instructions that are designed to
space. Checks or money orders made payable to the Oak Brook I recognize and acknowledge that there are certain risks of protect the participants’ safety. However, participants and
Park District. Include your telephone number on your check. physical injury to participants in the above program(s) and parents/guardians of minors registering for this program must
4. YOU ARE REGISTERED UNLESS WE INFORM YOU I agree to assume the full risk of any injuries, damages or recognize that there is an inherent risk of injury when choosing
OTHERWISE. loss regardless of severity which I or my minor child(ren)/ to participate in recreational activities.
5. Program registration is monitored throughout the season, and ward(s) may sustain as a result of participating in any and all
programs will be cancelled if there is insufficient enrollment at activities connected with or associated with such program(s). You are solely responsible for determining if you or your
least two days prior to the start date. The Oak Brook Park District I agree to waive and relinquish all claims my minor child(ren)/ minor child is physically fit and/or adequately skilled for the
maintains the right to open and close classes at its discretion. ward(s), or I may have as a result of participating in the activities contemplated by this agreement. It is always advisable,
6. If you register for a class but cannot attend, please notify the program against the District and its officers, agents, servants especially if the participant is pregnant, disabled in any way or
Oak Brook Park District at (630) 645-9590, as soon as possible to and employees. recently suffered an illness, injury or impairment, to consult a
cancel your registration. Other patrons are waiting to participate. physician before undertaking any physical activity.
7. Please do not bring your children to programs that you are The Oak Brook Park District does not carry accident or
participating in unless childcare is provided. hospitalization insurance on any program participant. It is WARNING OF RISK
8. If a program reaches its maximum in enrollment, the class will recommended that participants review their own personal Swimming is intended to challenge and engage the physical,
be “closed.” A waiting list is then started for those still interested in insurance policy for adequate coverage during all program mental and emotional resources of each participant. However,
registering for the program. When and if an opening occurs in the activities. I do hereby fully release and discharge the District despite careful and proper preparation, instruction, medical
program, the first person on the waiting list will be contacted. We and its officers, agents, servants and employees from any and advice, conditioning and equipment, there is still a risk of
will continue down the list, as more vacancies become available. all claims from injuries, damage or loss which I or my minor serious injury, including drowning. Understandably, not
Do not include payment with your registration form if you are put child(ren)/ward(s) may have or which may accrue to me or all hazards and dangers can be foreseen. The very nature of
on a waiting list. The registration fee will be collected if you are my minor child(ren)/ward(s) and arising out of, connected swimming is hazardous and risky, including but not limited
able to participate. with, or in any way associated with the activities of the to fatigue and overexertion, poor swimming skills, failing to
9. If a participant drops out of a program, and it has waiting program(s), (including transportation services and vehicle avoid dangerous areas, horseplay, diving or cannon-balling
list, the participant cannot give their spot to a friend. The Oak operations, when provided). into shallow water and striking the bottom or side of the pool,
Brook Park District reserves the right to assign participants to the inadequate supervision or instruction, lack of conditioning,
program in the order they are listed on the Park District’s waiting I further agree to indemnify and hold harmless and defend the becoming disoriented, striking other swimmers, defective or
list. District and its officers, agents, servants and employees from inadequate equipment, striking one’s head on the bottom when
10. The Park District is not responsible for any omissions or any and all claims resulting from injuries, damages and losses using a diving block, slip and falls on the deck or within the
typographical errors. sustained by me or my minor child(ren)/ward(s) arising locker facility, chemical exposure and all other circumstances
11. The Oak Brook Park District does not carry accident or out of, connected with, or in any way associated with the inherent to the sport of swimming. In this regard, it must
hospitalization insurance on any program participant. It is activities of the program(s). In the event of any emergency, be recognized that it is impossible for the (District/SRA) to
recommended that participants review their own personal I authorize District officials to secure from any licensed guarantee absolute safety.
insurance policy for adequate coverage during program activities. hospital, physician and/or medical personnel any treatment
deemed necessary for me or my minor child(ren)'s/ward(s)'s WAIVER AND RELEASE OF ALL CLAIMS AND
REGISTRATION PROCEDURE immediate care and agree that I will be responsible for ASSUMPTION OF RISK
Instant Online Registration begins at 12:01am on designated payment of any/all medical services rendered. Please read this form carefully and be aware that in signing
registration dates and is processed immediately. Registrations for up and participating in this program/activity, you will be
programs that are mailed, faxed, or in-person will be accepted As a participant in a program or activity of the District (or as expressly assuming the risk and legal liability and waiving and
upon receipt of the seasonal brochure, and held until the the parent or guardian of a participant), I hereby grant the releasing all claims for injuries, damages or loss which you or
registration day. All received registrations will then be processed District permission to use my or my child(ren)'s/ward(s)'s your minor child might sustain as a result of participating in
at random. Any registration received after 5pm on registration image, video form, or voice in photographs, videotapes, any and all activities connected with and associated with this
day will be processed randomly by date received. Proof of internet website or other materials prepared or released program/activity (including transportation services and vehicle
residency is required. The following items are accepted: by the District from time to time, for promotional, safety or operations, when provided).
• Most recent real estate tax bill instructional purposes. I understand that such materials will
• Drivers license be used and shown in whole or in part as the District sees fit. I recognize and acknowledge that there are certain risks of
• Lease agreement for currently occupied residence with building By this permission and release, I hereby release and discharge physical injury to participants in this program/activity, and I
owner’s certification of the names and birth dates of your resident the District, its officers, employees and agents from any and voluntarily agree to assume the full risk of any and all injuries,
children (required by Oak Brook Village Code) all claims or actions resulting from the use of such materials damages or loss, regardless of severity, that my minor child/
•Unpaid utility bill (payment stub attached) naming you the by the District. ward or I may sustain as a result of said participation. I further
responsible person at the Oak Brook address agree to waive and relinquish all claims I or my minor child/
•All participants must reside in Oak Brook to receive resident rate. When registering by fax or online at the Oak Brook Park ward may have (or accrue to me or my child/ward) as a result
•Corporate residents must verify employment within the Oak District, it is mutually understood that the facsimile of participating in this program/activity against the District,
Brook area via a letter on company letterhead from a Human registration document (including the Waiver and Release of including its officials, agents, volunteers and employees.
Resources representative verifying employment. All Claims) shall substitute for and have the same legal effect
•Verification must be provided annually. as the original form. I have read and fully understand the above important
information, warning of risk, assumption of risk and waiver and
CANCELLATION/REFUND I have read and fully understand the program details, release of all claims. If registering on-line or via fax, my on-line
A $5 service charge will be applied to each class cancelled if Waiver and Release of All Claims and Permission to Secure or facsimile signature shall substitute for and have the same
Treatment. legal effect as an original form signature.
received before a program begins. No refunds will be given
after the 2nd class has met. Prorated refunds may be issued if
accompanied by a signed note from a physician. The refund is
determined once the note is received. Refunds of 100% are made
if the park district cancels a program. www.obparks.org
FOR OFFICE USE ONLY:
Receipt #:___________________ Amount Paid:_______________ Date:___________ Staff:___________________You can also read
