Fitness Concepts for Life
RESERVATIONS / CANCELLATIONS
ALL STUDENTS MUST REGISTER HERE BEFORE TAKING CLASSES.
PLEASE FILL OUT THE FORM BELOW!
Indicates required field
DATE OF BIRTH
CELL PHONE #
I HAVE BEEN TREATED FOR...
EMERGENCY CONTACT #
HIGH FITNESS LEVEL - VERY ACTIVE
MODERATE FITNESS LEVEL - SOMEWHAT ACTIVE
LOW FITNESS LEVEL - NOT VERY ACTIVE
DATE OF FIRST CLASS
By submitting this Registration Form, you agree to the terms listed below!
It is understood that, as a student, I shall not bring or cause to be brought any action due to any personal or bodily injury or property damage that might result from the my participation in any exercise, dance or work-out as may be liberally interpreted whether under the supervision of any instructor or by my own direction. To restate, I agree to accept full responsibility and to hold harmless: Fitness Concepts for Life, Ripley-Grier Studios, New York Spaces and/or all persons in the aforementioned employ. The above medical history is complete and accurate. I will report immediately any change or omission in the above information or any new condition, defect, injury, pregnancy, etc., and upon doing so, I will remove myself from all classes until I present the teacher with a physician's medical release, at which time my continued participation will be at the teacher's discretion. I understand, however, that the teacher, by permitting me to continue, accepts no responsibility, and I will remain fully and soley responsible for any injury or damage.
Call (212) 799