Move & Groove: SHED IT! Registration

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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Please enter a valid phone number.
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Email* This field is required.Please enter your preferred email address for ongoing correspondence about the program.
example@example.com
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Gmail* This field is required.You will need a valid gmail/google account in order to access the pre-recorded videos on YouTube. If the above email address is a gmail account, simply re-enter it.
example@gmail.com
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Are You Experiencing Any of the Following Symptoms:* This field is required.Please select all that apply. These are general symptoms, and they can vary from person to person. There may also be symptoms not listed.
Hot flushes (aka personal chinooks... lol)
Insomnia/poor sleep
Mood swings (especially sudden onset)
Weight gain (especially belly, hips & thighs), even though you're exercising and eating well
Night sweats
Anxiety and/or depression
Joint and/or muscle pain, especially around the hips and knees, and it's worse in the mornings
Irregular menstrual cycles (or full cessation of monthly periods)
Urinary tract infections
Vaginal dryness
Brain Fog (difficulty finding words or remembering)
Headaches
Increased hair loss
Sensitive teeth and/or painful gums
I have not experienced any of these symptoms yet
I have experienced symptoms (please check them off above) in the past but they have diminished or have completely stopped
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Please select your Payment Schedule/Fee Option:* This field is required.SAVE by paying the full program cost of $600.00 CDN up front! You also have the option of paying monthly with an added $2/month administrative fee as shown below. All fees are non-refundable, and upon receipt of your first installment, you acknowledge that you will fulfill the financial obligation by paying monthly for the duration of the 6-month program, even if you opt not to complete the program, regardless of the reason. If there is a specific date each month that works best for payments for budgeting purposes, please email walkstrongcalgary@gmail.com to make arrangements.
I will pay the full Fee of $600.00 CDN Up Front
I will pay a monthly Fee of $102.00 CDN with the understanding that this monthly fee is due for the duration of the 6-month program, whether or not I complete the full term.
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I will be paying by:* This field is required.Payment is due upon registration.
Electronic Funds Transfer (EFT) to walkstrongcalgary@gmail.com
PayPal IN FULL $600.00 CDN - see next screen
PayPal - Monthly Installments $102.00 CDN - see next screen
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PayPal Payment Options (skip if paying by EFT)If paying by monthly installments, your first installment is due upon registration. Please contact walkstrongcalgary@gmail.com to schedule your subsequent payments. Once you select your payment option below, complete the rest of the registration form and when you click submit you will be re-directed to PayPal's payment screen - follow the instructions therein. You will be able to pay by credit card. If making monthly installments, go to page 2 below to make your selection.
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ORDER SUMMARY
Total costCAD
One-Time PaymentFull payment up front (all fees non-refundable)
$600.00CADEdit
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Quantity
Monthly InstallmentsFirst installment due upon registration. All fees non-refundable, full 6-month financial obligation to be paid whether or not program is completed.
$102.00CADEdit
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Total cost $0.00CAD
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Please Read Carefully:

Exercise Release Agreement and Waiver of Liability

I hereby warrant, represent, and state that I am in good health and that I have no disability, impairment or ailment that will prevent me from engaging in active or passive exercise or that will be detrimental or inimical to health, safety, comfort or physical condition. I hereby indemnify and hold harmless the Staff and Management of Witness 4 Fitness from any condition including physical injury, damage, loss or other liability arising out of any passive or active exercise in which I engage through the auspices of Witness 4 Fitness and the "Move & Groove: SHED IT!" program regardless of degree of responsibility or negligence. I further and specifically agree, on behalf of myself and all respective heirs, executors, administrators, successors and assigns, that staff and management of Witness 4 Fitness shall not be liable for any claim, demand, or cause of action of any kind resulting either directly or indirectly from or related to my participation in this program, whether any such loss, damage, or physical injury may be caused by negligence or in any other manner whatsoever and I agree to hold Staff & Management of Witness 4 Fitness harmless from the same.
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I acknowledge and represent that I have read the foregoing "Exercise Release Agreement and Waiver of Liability", understand its contents, and am in full agreement with the statements therein. (Participants under 18 must have the consent of a parent or guardian.)* This field is required.
YESNO
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Please provide your consent to receive emails from walkstrongcalgary@gmail.com related to program content, including links to pre-recorded videos. Your email address will not be shared with third parties.* This field is required.
I consent to receive emails
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