Exercise Class Attendance Form

Please take a moment if you have a SilverSneakers or Silver & Fit membership with the Whitney Senior Center. We will submit your attendance for reimbursement to help pay for the instructor's time. Thank you. If you do not have insurance, consider making a donation.

If you have any questions, please feel free to give Paula a call at 320-255-7265.

Reminder - if you have not filled out a Fitness Waiver to participate in the classes, please go back to the newsletter to find the link to fill it out.
Name

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please Note --If you do not have the SilverSneakers or Silver & Fit set up with the Whitney Senior Center and would like to go ahead and set up- please call our Front Desk M-F 8:00am to 4:30pm to provide your Birthdate and SilverSneakers number to set up by calling 320-255-7245.
Please Mark the dates you attended a Virtual Class to include Senior Yoga, SAIL, Pilates, and Tai Ji *

Mon, Nov 2 Tue, Nov 3 Wed, Nov 4 Thurs, Nov 5 Fri, Nov 6 Sat, Nov 7 Mon, Nov 9 Tues, Nov 10 Wed, Nov 11 Thurs, Nov 12 Fri, Nov 13 Sat, Nov 14 Mon, Nov 16 Tues, Nov 17 Wed, Nov 18 Thurs, Nov 19 Fri, Nov 20 Sat, Nov 21 Mon, Nov 23 Tues, Nov 24 Wed, Nov 25 Thurs, Nov 26 Fri, Nov 27 Sat, Nov 28 Mon, Nov 30
Please write any comments here.
Please use your cursor or fingertip on touchable screen to sign to confirm the above dates you selected. Whitney will submit appropriately to SilverSneakers or Silver & Fit.
Signature

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Signature date
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