Fitness Class Safety Form
Share your emergency contact and any injury or medical concerns before class.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Don you have any current or past injuries or medical conditions we should be aware of that may affect your ability to participate in Zumba?
Consent
I understand that I should work within my own fitness level and stop if I feel unwell
I agree to let the instructor know if there is any change to my health
Submit
Should be Empty: