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Health Waiver
Please fill out the following form before attending your first class
First Name
Email Address
Last Name
Date of Birth
Have you experienced any of the following? Check all that apply
*
Required
Diabetes
Epilepsy
Chest Pains
Dizzyness or Fainting
Arthritis
Bone
Asthma or respiratory problems
Allergies
None
Is there any reason why you should refrain from physical activity? Please mention any injuries we should know about.
Emergency Contact Information
Initials
Today's Date
I declare that the info I’ve provided is accurate & complete
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