Name
*
Street Address
*
City
*
State
*
Zip Code
*
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Age
*
Best phone number to reach you
*
Email
*
Rate your fitness level 1-10 (1 being the highest)
*
Please decribe your main fitness goals.
*
Personal Medical History
Do you have any personal medical conditions that would prevent you from participating in exercise?
*
Yes
No
Have you ever had an injury that would prevent you from participating in exercise?
*
Yes
No
If you answered yes to either of these questions, do you have your physicians permission to participate in this program?
*
Yes
No
Did you answer "no" to any of the questions above?
If so, we cannot allow you to participate until you have the proper clearance from your doctor. Notice: It is recommended that you seek your doctors advice before beginning any health/fitness program.
Physical Activity Readiness Questionnaire
Regular exercise is associated with many health benefits, yet any change of activity may increase the risk of injury. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each question carefully and answer every question honestly.
Has any physician ever said you have a heart condition and you should only do physicalactivity recommended by a physician?
*
Yes
No
When you do physical activity, do you feel chest pain?
*
Yes
No
When you were not doing physical activity, have you had chest pain in the last month?
*
Yes
No
Do you ever lose consciousness or do you lose your balance because of dizziness?
*
Yes
No
Do you have joints or bone problems that may be made worse by a change in your physical activity?
*
Yes
No
Is a physician currently prescribing medications for your blood pressure or heart condition?
*
Yes
No
Are you pregnant?
*
Yes
No
Do you have insulin dependent diabetes?
*
Yes
No
Are you 69 years of age or older?
*
Yes
No
Do you know of any other reason you should not exercise or increase your physical activity?
*
Yes
No
Did you answer "yes" to any of the questions above?
If so, please talk to your doctor or physician BEFORE, you become more physically active. Tell your doctor your intent to exercise and to which questions you answered yes. If you honestly answered no to all questions you can be reasonably positive that you can safely increase your level of physical activity gradually. If your health changes so you didn’t answer yes to any of the above questions, seek guidance from a doctor. Please make sure you are 100% committed to completing the program as no refunds are given.
By entering you name below, you have acknowledge that you have answered the questions truthfully and are able to partake in an excersie routine.
*
Date of completion
*
-
Month
-
Day
Year
Date Picker Icon
Signature
Liability Release Form, Discharge and Covenant Not to Sue
This is a legally binding release waiver, discharge and covenant not to sue, made voluntarily by me, the undersigned releaser, on my own behalf and on behalf of my heirs, executors, and Harmony Health and Fitness administrators and or the owners of 16100 Poplar Creek Rd. I hereby consent to voluntarily engage in an exercise conditioning class that might include, but is not limited to, the following activities: walking, jogging, running, sprinting, jumping, going up and down stairs, punching, squatting, balance work, calisthenics with medicine balls, exercise bands, agility, endurance, speed, stretching, abdominal and functional training equipment and work. The levels of exercise that I will perform will be at my own pace, based upon my cardio respiratory fitness, muscular strength and endurance. I understand that there are risks that may be associated with any exercise program. I hereby state that I will inform harmony health and fitness of any symptoms during my participation in the exercise class that occur such as fatigue, shortness of breath, chest discomfort. I take full responsibility for stopping an activity myself if it becomes painful or hazardous to my health. I will be given instructions on how to perform an exercise and will ask any questions of harmony health and fitness if I do not understand. Harmony health and fitness will provide leader ship to direct my activities, monitor my performance, and otherwise evaluate my effort. If I have high blood pressure, diabetes, heart condition, or if I am taking any prescribed medication that will affect my performance in an exercise class, I will inform harmony health and fitness prior to participating in the class. I acknowledge that any type of exercise involves a risk of injury. Harmony health and fitness and/or 16100 Poplar Creek Rd., Athens, AL 35611 shall not be liable for any injuries or damage to the undersigned, or of the property of the undersigned, or subject to any claim, demand, injury or damages whatsoever, including, without limitation, those damages resulting from acts of active or passive negligence on the part of the class participants for the releaser. As the undersigned releaser I recognize that this release means I am giving up, among other things, all legal representatives and signs. It is agreed that harmony health and fitness shall not be responsible or liable to the undersigned for articles lost or stolen in connection with harmony health and fitness.
I have read the entire release. I fully understand the entire release and acknowledge that I have had the opportunity to review this release with an attorney of my choosing if I so desire, and I agree to be legally bound by the release. This is a release of your rights, read carefully and understand before signing. - Please enter your full name.
*
Date of completion.
*
-
Month
-
Day
Year
Date Picker Icon
Signature
Media Release Form
I grant permission to Harmony Health and Fitness to use my image for use in Mediapublications including: Videos, Brochures, photographs, & Social Media content. I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Do you consent?
*
Yes
No
Please enter your full name below.
*
Date of completion
*
-
Month
-
Day
Year
Date Picker Icon
Signature
What time would you like to workout?
*
6:00 AM CST
8:00 AM CST
What time zone do you live in?
Where did you learn about Harmony Health and Fitness? (Please choose all that apply)
Facebook
Instagram
Website
Friend's Post
Darlene H Lee Post
Darlene H Lee's Story
Harmony Health and Fitness Page Post
Harmony Health and Fitness Story Post
Other
Back
Next
On Demand Library- Full Access
My Products
prev
next
( X )
One Month Access
$
19.95
This option gives you access to all classes for one month. New monthly downloads and a year full of workouts in the On Demand Virtual Library available 24/7.
1 Year All Inclusive Membership
$
199.95
This option gives you access to all classes, challenges, lives, and recordings for one year.
1 week trial membership
$
Free
1 week
Gift Certificate
$
19.95
1 month of classes and access to recordings.Gift certificate will be sent via email after purchase.
Total
$
0.00
Should be Empty: