Spirit Club Fitness Registration

Spirit Club Fitness Registration
Disability Network is offering an inclusive fitness program facilitated through Zoom. Join us on Friday mornings at 10:00AM from the comfort of your home for Spirit Club - designed for people of all abilities to work out comfortably without needing equipment. Come join skilled, virtual trainers who make exercise fun with dancing and music!

**This program is only virtual at this time**

DNNM collects demographics for reporting and funding purposes. Your information will be confidential.
I am interested in participating in the following events (check all boxes for classes you want to attend):

Virtual Zoom Wednesdays at 1:30 pm ESTIn Person at Traverse City office Wednesdays at 1:30 pm EST (two or more participants required to provide this option)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
What is your Ethnicity?
What is your primary disability?
Do you require any accommodations to participate in Spirit Club? Staff are happy to assist with answering question if you are not sure.
Please list your emergency contact
Emergency Contact phone number
Please enter a valid phone number.
Do you have any physical or health restrictions we should know about? Please explain
What is your goal with participating in Spirit Club?

To increase my physical fitnessTo learn more about physical activity and healthy lifestyleTo explore physical activity within my own homeOther
If other please explain
What device are you using to join Spirit Club? we use zoom to connect
Do you need assistance connecting to zoom?
I acknowledge that: 1.)I am voluntarily engaging in physical exercise 2.)I have no physical or mental health conditions, including, without limitation, any cardiovascular, neurological, disease or other condition that will prevent me from participating in any SPIRIT club program, without injury to myself or impairment to my health, AND, 3.)I know it is recommended by SPIRIT Club that only individuals approved for exercise by their doctors participate in SPIRIT Club's virtual classes. By signing my name below, I agree to these statements
The undersigned parent or legal guardian of the minor/student named below OR adult (18yrs+) and own guardian, voluntarily and in consideration of allowing participation in the DNNM Spirit Club fitness program, hereby, agrees to release, discharge, hold harmless and waive any and all claims including negligence claims for personal injury to my child or child’s property that may be caused by any act, or failure to act, by DNNM and each and all of its elected and appointed officials, employees, volunteers, representatives and agents and each and all of its employees and representatives in connection with or arising out of the participation of the undersigned in this activity. This waiver binds me, the undersigned, the minor and the minor’s heirs, executors and assigns. I also understand all risks involved in DNNM Spirit Club fitness program and have had the opportunity to contact DNNM or its agents and employees to ask any questions that I may have, and on behalf of the minor/person named below, I assume the risk of all dangerous conditions associated with this activity and agree that I am solely responsible for any injuries incurred by my minor/student in connection with this program. I certify that the minor/student named below is eligible to participate in DNNM Spirit Club fitness program. Caution: Please read the above before signing. By signing this agreement, you are agreeing that you will not sue the DNNM, its employees, officials, volunteers, representatives, or agents in connection with the below-named minor/student/participant participation in DNNM Spirit Club fitness program. By entering my name below I agree to these statements:
Signature

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We are excited to have you join Spirit Club! Staff will be contacting you with more information.
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Spirit Club Fitness Registration

We are excited to have you join Spirit Club! Staff will be contacting you with more information.