Women's Fitness Class Registration

1

Address: 2751 E 9th Street, Suite B
Newberg, OR 97132
45-Minute Class - located upstairs

$15 per class

AGES 18+ ONLY

2

Full Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

Cell Number* This field is required.

Please enter a valid phone number.

5

Select Your Class Session* This field is required.

6

Would you like to schedule a second class?* This field is required.

Yes

No

7

Select a Second Class Session

8

Would you like to schedule a third class?

Yes

No

9

Select a Third Class Session

10

Would you like to schedule a fourth class?

Yes

No

11

Select a Fourth Class Session

12

Would you like to schedule a fifth class?

Yes

No

13

Select a Fifth Class Session

14

Would you like to schedule a sixth class?

Yes

No

15

Select a Sixth Class Session

16

LIABILITY WAIVER

I hereby certify and represent that I am of sound mind and in good physical condition and that I am 18 years of age or older. I agree that all training recommendations given, are undertaken at the sole risk of me. Newberg BJJ, LLC dba Impact Training Center and Impact Performance Training (referred to as GYM) is not liable for any claims for injuries or damages, whatsoever, to me or my property, arising out of or in connection with, the training and recommendations given by GYM.

I agree to indemnify and hold harmless GYM, its employees, subcontractors and representatives from all claims of liability by me. I also certify and represent that I agree to abide by all rules and regulations of the GYM.

17

I have read and agree to Liability Waiver.* This field is required.

YES