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

Sacramento

Roseville

Invite Code RISEPF

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