4TFM Registration Form

www.fitwithkg.com

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Cell phone for text

For Prep4Birth, when is your due date and where are you having your baby?

Due dateWhere are you having your baby?

For Postpartum Recovery, what is your baby’s name and DOB

First NameDOB

Whom may I thank for referring you to my classes? Anything else that you want me to know?

Are you interested in more info regarding Personal training?

Waiver I understand that physical exercise can be strenuous and there is inherent risk in participating in any exercise program. I agree to assume those risks personally and hereby release 4th Trimester Fitness® LLC, its members, managers, employees, agents, representatives and instructors (the “Released Parties”) from any and all claims or liability, loss or expense for any injury or discomfort I or my baby may sustain as a result of my participation in this program. I understand that I am not required to participate in any or all of the body movements demonstrated by the 4th Trimester Fitness® LLC instructor, and that nothing we do in class should ever be painful. I represent that I have consulted with my physician before participating in this activity. I understand that this is a group fitness class, that the Released Parties are not providing physical therapy or medical services, advice or treatment, and that the Released Parties are not acting as my physician, physical therapist, or one-on-one personal trainer. I give permission for photographs taken of me while participating in the class to be used in social media and marketing/public relations materials in the promotion of 4th Trimester Fitness® LLC and its classes. At any time during class, I can let the instructor know that I prefer not to be photographed.