Empower Me Fitness Classes Enrollment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Enrollment form for Mums & Bubs classes with Caren Van Gastel at Empower Me Fitness & Consulting.

First time enrolment? - please answer all questions.
Returning for another term? - please confirm preferred class time and update any details as required.

Email *

Which class are you enrolling in? Enrolments open for Term 1, 2024 classes - commencing 31st January 2024). Trial classes available for $10. *

Tuesday Morning 10:00am - Mums & Bubs (Mornington) - 1 spaces remaining

Thursday Morning 9:30am - Mums & Bubs (Mornington) - 5 spaces remaining

I'd like to try a class first - please select your preference in the next question.

Required

Trial option only: Please indicate your trial class preference.

Tuesday 10am

Thursday 9:30am

Clear selection

Name

Date of Birth

YYYY

Phone Number

Address

Emergency contact name & phone number

Occupation (prior to baby)

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms