Class Registration

Fill out this form to register for class. Fields marked with * are required. You will receive a thank you message if your form has been submitted. You should get an instant email reply, if you do not, please contact Karissa.

*Name

*Email

*Name of Class

*Class Location 1st Choice

*2nd choice if 1st location becomes full

*Class Dates/Times

*Program of Interest

*Current Level of Conditioning

*If you have previously accomplished a 5K, would you be interested in a 10K option with this class for an additional fee?

*Would you be interested in a short strength/toning boot camp before or after class for an additional fee?

*How did you learn of this class? If from a friend, please include their name.

*Date of Birth

*Address

*City

*State

*Zip

*Home Phone

Work Phone

Cell Phone

*Emergency Contact

*Relationship to you

*Emergency Phone

Children
(names, ages and place an X if they will participate)

*Shirt Size

*Shirt Type

*Briefly describe what interests you about this training?

*What do you hope to accomplish with this exercise program?

*What special challenges do you find in reaching your personal health and fitness goals?

*Please describe any current or recent health conditions, and past or present injuries and exercise-related pains

*Briefly describe your current fitness level and exercise program (or lack of! ☺)

*Please describe your general eating habits, or indicate if you are on a special diet. (low or high calorie, low carb, cholesterol, salt, or fat, etc.)
(low or high calorie, low carb, cholesterol, salt, or fat, etc.)

*Please list your most important exercise goals

In addition to the classes, which of the following additional services (free of charge) would you be interested in with your training experience? Please check any that interest you.
Body Composition:

Accountability Partner

Online Nutrition Tracking

Online Exercise Tracking

Other
Please enter what additional services you would like.

*Required