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Trap Fitness Registration Form & Disclosure
Please read the agreement in its entirety and digitally sign and date below.
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Email
*
Your email
Participant Information
Participant Name (type full name below)
*
Your answer
Participant Address (type address below)
*
Your answer
Date of Birth (Month and Day Only)
*
Your answer
Phone Number
*
Your answer
Best Time to Contact You?
*
Evenings
During the Day
Anytime
Other:
Required
Emergency Contact
Contact Name
*
Your answer
Relation to Participant
*
Your answer
Phone Number
*
Your answer
Email
Your answer
Medical Information
Are you currently under a physician's care?
*
Yes
No
Do you have any of the following?
*
No, I do not have any illnesses
Diabetes
Asthma
Hypertension
Heart Disease
Sleep Apnea
Major injuries (e.g. fractured or broken bones, torn ligaments, etc.)
Arthritis
Other:
Required
In case of an emergency, do we have permission to call an ambulance to transport you to the nearest hospital?
*
Yes
No
Undecided
Registration
Please check to acknowledge registration.
*
I request registration in the Trap Fitness with Pretty Girls Group Fitness Classes.
Required
Trap Fitness: Birthday Special!!!
During your birthday month, monthly tuition is only $100 (with online subscription).
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