Athlete Intake

Gym Membership

Enrollment Fees: There is a one-time fee of $40 (with the exception of prepaid plans and certain plans under insurance discount programs).

Membership fees vary depending on commitment level chosen.

Full Name*

Birth Date*

MonthDayYear

Guardian Name (if under 18)

First NameLast Name

Address

State

City

Zip Code

Phone Number

Email Address*

Gender

MaleFemale

TYPE OF MEMERSHIP*

I.E. GovGuam, Select Care Federal, Take Care Federal, Private (please specify), etc.

EMERGENCY CONTACT INFORMATION

Contact Name

Contact Phone Number

Relationship

Signature*