Twerk Fit Registration & Liability Waiver

Twerk Fit Registration & Liability Waiver

Register for Twerk Fit classes and complete your liability waiver. Move with confidence—let’s dance safely together!
Personal Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Health & Fitness Background
Current Fitness Level
Do you have any of the following medical conditions?

Other
If you selected 'Other', please specify:
Are you currently under a doctor's care or taking medication that may affect your ability to exercise?
If yes, please provide details:
Class Preferences
Which classes are you interested in?
Preferred Schedule
How did you hear about Twerk Fit?

Other
Emergency Contact
Emergency Contact Full Name

First NameLast Name
Relationship to You
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Liability Waiver & Release
Liability Waiver & Media Release
I acknowledge that participation in Twerk Fit classes involves physical activity and carries inherent risks. I release Twerk Fit, its instructors, and affiliates from any liability for injuries or health issues that may arise from my participation. I confirm that I am physically fit to participate and will consult a physician if needed. I also consent to the use of photos or videos taken during classes for marketing purposes.
Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Twerk Fit Registration & Liability Waiver

Personal Information

Health & Fitness Background

Class Preferences

Emergency Contact

Liability Waiver & Release