DHF Wellness Champion Application Name(Required) First Last Phone(Required)Email(Required) Truck Number (if applicable) Driver Code/User Code(Required) Which are you?(Required) Driver In-House Division or Department How did you hear about the Wellness Champion program?(Required) I am volunteering as a Wellness Champion because...(Required)Agreements: Please check the boxes to verify your eligibilityI agree to be a DHF Wellness Champion and promote a culture of wellness in my work environment.(Required) Yes, I agree I give permission for DHF Wellness Champion Network to use my name and image on the website and in promotional materials, and to share my demographic information within the Champion network.(Required) Yes, I agree If I am no longer able to serve in this role, I will do my best to find a co-worker who could fulfill this role.(Required) Yes, I agree.