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Class Registration Form
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Class Schedule
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Name (First and Last)
*
E-mail
*
Address
*
City
*
State
*
Zip Code
*
Date of Birth
*
Mobile Phone
*
Please select one or more registration options:
*
Boot Camp - 1 Class ($25)
Boot Camp - 1 Month ($175)
Boot Camp With A Buddy - 1 Month ($150)
Nutrition Evaluation ($30)
Yoga - 1 Class ($15)
Yoga - 4 Classes ($40)
Nutritionist Consultation ($85)
Release of Liability (Please read and check all the statements below):
*
Prior to beginning any exercise program, you should obtain a physician's approval. By checking this box, you are certifying that you have obtained a physician's permission to participate in an exercise program, or have decided to participate in activites without the approval of your physician, and therefore assume all responsibility for your activities.
I understand that engaging in an exercise program could be a potentially dangerous activity. I hereby acknowledge that my participation in any activity associated with The Body Elite is entered into voluntarily with the knowledge of the dangers involved. I agree to expressly assume and accept any and all risks including injury or death.
I also agree to waive, release and forever discharge The Body Elite and its officers, agents, employees, representatives, executors, and all others from my participation in any activities resulting from said exercise programs.
I also understand that checking the above statements will be considered as my signature for all correspondence between myself and The Body Elite.
Please choose your payment method (Payment is due on or before the first class day.):
*
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Check
Credit or Debit Card
Credit/Debit Card Type:
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Card Number:
Card Expiration Date (mm/yy):
3-Digit Security Code (4-Digit for AmEx):
Billing Zip Code:
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