Fitness Center Application
In an effort to provide the safest and most effective program, it is necessary for all clients to complete this application.  All information contained on this application will remain confidential.  

The completion of this application does not guarantee your participation in our program. For additional questions/concerns, please contact us at fitness@splitsecondfoundation.org or by phone at 504-354-2149.

Gym membership fee is $50/month. Guided workout sessions with an adaptive fitness specialist are $25/hour.
Email *
Client Name *
First and last name
Address *
City, State *
Zip code *
Phone number *
Date of birth *
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Height *
Weight *
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