Clone of Fitness Class Template Registration

Join Paula for a Dance Fitness Class where you have fun working up a sweat to some fun tunes! Great for a variety of abilities and ages.

Cost is $40 for all 9 sessions and pay ahead easily, or drop in for $5/class (cash only).

When: Wednesdays October 1 to November 26, 2025 from 6:30pm-7:30pm.

Located at the Sexsmith Civic Centre on 99 Ave, main hall.

*Participants will need gym attire and clean shoes. Bring a water bottle.

Questions? Contact wellness@sexsmith.ca for more info.

Fee can be paid by e-transfer or pay in cash at your first session. Fees can be paid by e-transfer (payment@sexsmith.ca, note Fitness Class ). If cost is a barrier, talk to Melody at wellness@sexsmith.ca.

Participant Name*

First NameLast Name

Birth Year*

Address*

Mailing Address

City

Postal Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Parent/Guardian Information *If participant is under 18*

Name

First NameLast Name

Phone Number

Cell Number

Emergency Information

Alternative Contact's Name*

First NameLast Name

Relationship

Phone Number*

Does the participant have chronic illness or medical conditions that would be affected by participating in this program? Do they need to carry medication? If yes, please describe.

In consideration of being allowed to participate in any way in the Town of Sexsmith programs (hereby referred to as “the Program”), related events and activities, the undersigned acknowledges, appreciates, and agrees that:

I hereby freely accept all of the risks (known and unknown) however caused associated with participation in the Program, whether the risks result in personal injury, property damage, death or some other harm to me.

I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

As a condition of the Municipality allowing me to participate in the Program, I (for myself and on behalf of my heirs, next of kin, and personal representatives) agree to waive all claims that I have or may have in the future against the Municipality, its officers, officials, agents and/or employees, other participants, and sponsoring agencies/advertisers for any injury, property damage, financial loss, or any other loss that may result directly or indirectly from my participation in the Program, no matter how this loss is caused (including negligence on the part of the Municipality).

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

We are seeking your permission for the participant's image to be taken and used as a visual that may be incorporated into publications, advertisements, presentations and/or web pages, produced for the purpose of promotion of The Town of Sexsmith programs and services.*

YesNo

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Fitness Class Registration

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