Myers Fitness Centre waiver Form

DAY PASS PROGRAMS

SPIN CLASS=$1000

MORNING CLASS=$500

EVENING AEROBICS CLASS=$500

PHYSICAL GYM AND UTILITIES=$1000
REGISTRATION
What is your name?

First Last
Phone Number

Area CodePhone Number
What will you be doing today?
Self Assessment Information
Have you done any workout programs before?

YesNo
Please specify which workout programs have you done?
When was the last time you have participated in physical fitness programs?

1 Month Ago2 Months AgoN/AOther
Medical Information
Are there any illnesses, medical or physical condition or have you ever done surgery that may have a negative impact while exercising?(Please specify below)
Please provide the details and frequency of dosages. Enter N/A if none (Please answer truthfully as failure to provide truthful information in regards to your medical history that could be made worst by working out could result in severe injuries. Be cautious, clients workout at their own risk, Myers Fitness Centre will not be held accountable for any injuries that may be sustained while using the facility).
Disclaimer
Signature
ACCOUNT INFORMATION
SCOTIA BANK OCHO RIOS, AC#600674 MYERSFITNESS CENTRE, BNS OCHO RIOS, BUSINESS ACCOUNT
CONTACT US @ 876-441-2032/876-622-3887, myersfitnesscentre@outlook.com.
PLEASE FORWARD ALL PAYMENTS RECEIPT TO myersfitnesscentre@outlook.com or whatsapp 876-796-3679
Should be Empty:

REGISTRATION