Individual Registration

Registrant Information

Name:


First	Last

Address:

City, State Zip:

Phone:

Email:

Cell Phone:

Emergency contact name and relationship:

Emergency contact phone:

Permission to be photographed by media for newspaper, newsletters, and websites:

Season:

Method of Payment:

Payment Terms ( $7.00) dollars admission:

Is your doctor aware that you are participating in an exercise program?:

Comments:

Delay becoming much more active if you are not feeling very well because of a tempory illness such as a cold or fever - wait until you feel better.

Please note: If your health changes, consult your doctor to see if you should change your physical activity plan.

By submitting this registration form, I acknowledge that I have read, understood and completed this registration and questionnaire. Any questions were answered to my full satisfaction.

I have read and agree to all terms and conditions above