Fitness Fusion Registration 1












        

* indicates required fields 
  *Name:
  *Address:
  *E-mail and Phone Number:
  *Emergency Contact - Name, Relationship, Number:
  *Health Information:  I have a bone, muscle, or joint problem.
 I have a medical condition.
 I have asthma.
 I've had a physical within the last year.
  *Health Information Explanation:
  *Exercise Experience:  Beginner - Strength/Resistance Training
 Intermediate - Strength/Res.
 Advanced - Strength/Res.
 Elite - Strength/Res.
 Beginner - Cardio Conditioning
 Intermediate - Cardio Conditioning
 Advanced - Cardio Conditioning
 Elite - Cardio Conditioning
 I have no regular exercise experience at all
  *Goals:
  Additional Information I want you to know:
  *Class:  Briarcrest Christian School - 8:15AM Mon/Fri
 Briarcrest Christian School - 6:00PM Tue/Thur
 Healthy Habits Studio - AM
 Healthy Habits Studio - Mid
 Healthy Habits Studio - PM
  T-shirt:  Small
 Medium
 Large
 X-Large
 XX-Large
  *Payment:
  B4 & After Pictures:  Yes, I would like b4 & after pictures!
 No thanks

Fitness Fusion Registration Part 2 - Release of Liability/Authorization of Risk Form
Please submit completed form by fax to 901.248.6848 by (e) Admin@BeccaMarinoFitnessInspiration.com
or print and bring with you to the first session.

The undersigned participant, in consideration of participation in this program, activity and/or class indicated on this form, agrees to indemnify and hold harmless Fitness INSPIRATION! Inc. I am aware that when training I expose myself to physical risk, I take full responsibility for any injuries that I may suffer and/or loss of property. I acknowledge that I am in good health and am capable of participating in an exercise program, and I release Fitness INSPIRATION! Inc. and its certified personal trainers’ from any responsibility for any injury or damage to me.

Signature _________________________________   Date __________

Last Name ___________________First Name ____________________

I have read and agree to the terms and conditions set forth in this agreement. ______ Initial

Witness ____________________________________  Date _________

Thank you :)

 
 
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