The "Start Here" Women's Collective Fitness Group 🐕‍🦺👟

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

What are your interests related to wellness? Do you have a goal in mind? What is your current activity level? ("no activity" is an acceptable answer, we all start somewhere!)

Will you be bringing a dog?

Dog's Name

Dog's Breed

Is your dog spayed or neutered? (females in season may not attend. Unaltered males must be under control)

Has your dog ever shown aggression or attempted to bite another dog or person?

Does your dog get along with other dogs? (Note: dogs will NOT be interacting with each other. Each dog is expected to be leashed and kept close to the owner)

Do you (or your dog!) have any health related issues (high blood pressure, diabetes, or anything for which you are under the care of a medical professional)? Have you had any previous musculoskeletal injuries (sprains/strains of back, legs, hips)? These do not prevent you from joining, just helps us keep you safe!

Disclaimer: By submitting this form, you confirm that the information you provide is accurate to the best of your knowledge. Now for the part they make me do:

Medical Disclaimer & Assumption of Risk
This program is provided for educational and general wellness purposes only and does not constitute medical advice, diagnosis, or treatment. Participation in any exercise program carries inherent risks, including but not limited to musculoskeletal injury, cardiovascular events, falls, and other potential harm.

By choosing to participate, you affirm that you are physically able to engage in this program and agree to consult with a qualified healthcare provider prior to beginning if you have any medical conditions, are taking medications that may affect exercise tolerance, or have concerns about your readiness for physical activity.

You understand and acknowledge that participation is voluntary and undertaken at your own risk. You agree to assume full responsibility for any and all injuries or damages that may occur as a result of participation, and you release and hold harmless Care Starts Here, its owners, instructors, affiliates, and representatives from any and all claims, liabilities, or causes of action arising out of or related to your participation.

You agree to immediately discontinue activity and seek medical attention if you experience symptoms such as chest pain, dizziness, shortness of breath, joint pain, or any other concerning signs.

Which day would you like to register for?

Email Address

example@example.com

The "Start Here" Women's Collective Fitness Group 🐕‍🦺👟

Registration Day