MOMentum Registration

MOMentum Class

with Kari Miller
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
What are you interested in?
How long have you been a mom? (This helps me understand where you are in your postpartum journey!)
What kind of birth did you have?

Natural BirthI'm a C-Section MamaIt's Complicated
What is your fitness goal for attending this class?

Postpartum Core HealingStrenghteningMobility & FlexibilityOverall Fitness
Do you have any existing injuries or health concerns that I should be aware of?

YesNo
If Yes to the above question, Please list here
Choose your Training Block/Interest
Do you require any special accommodations for the class? (Type Yes or No. If Yes, Please Specifiy)
How did you hear about this class?

InstagramWord of MouthReferralOther
Any other info or notes you may want me to know?*
Should be Empty:

MOMentum Class