ELEVEN7 · Reserve Your Spot
Complete this form to hold your spot for 15 minutes before checkout.
Your ticket
Which ticket are you reserving?
*
Early Bird · $25
VIP The Haus List · $65
Choose your workout
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Pilates 11:30 AM
Pilates 1:30 PM
Boxing 12:15 PM
Boxing 2:15 PM
Choose your two workouts
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Pilates 11:30 AM + Boxing 12:15 PM
Pilates 11:30 AM + Boxing 2:15 PM
Pilates 1:30 PM + Boxing 12:15 PM
Pilates 1:30 PM + Boxing 2:15 PM
Guest information
Full legal name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip code
*
Age range
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18 to 24
25 to 34
35 to 44
45 to 54
55 and over
Instagram handle
Emergency contact name
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First Name
Last Name
Emergency contact phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health and safety
Anything we should know to keep you safe on the mat or in the ring?
Are you pregnant, recovering from an injury, or managing a heart, blood pressure, or circulation condition?
*
Yes
No
Have you cold plunged before?
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Yes
No
Assumption of risk and release
Consent and release
Acknowledgements
*
Assumption of risk for cold water immersion
Assumption of risk for physical movement and outdoor conditions
Photo and video release allowing Haus of Wellness to use event photos and video
Electronic signature
*
Today's date
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Consent statement
How you found us
Is this your first Haus of Wellness event?
Yes
No
How did you hear about this event?
*
Instagram
A friend told me
A vendor or instructor
Daniel Dentistry
SweatPals
Somewhere else
Would you like to hear about the next one?
Yes
No
Reserve and continue to payment
Reserve and continue to payment
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