Personal Details
Please fill out your personal details below
Child 1 Name:
*
First Name
Last Name
Child 1 age:
*
Child 2 Name:
First Name
Last Name
Child 2 Age:
Parent Name
*
First Name
Last Name
Parent Phone Number
*
-
Area Code
Phone Number
Parent Email
*
example@example.com
Please list the main reasons you would like your child/ren to join our Teen Program
Example: Social connection, become more active, help with anxiety
Please list any medical conditions or medications your child/ren are on
Please state name, condition and medication
Any special note's our trainer might need to know?
Example: Jake is very shy until he get to know you.
Will the Parent be joining in on the session ?
Yes, I want to exercise and support my child
No thank you
Maybe, I'm not sure
How did you hear about Feel Good Fitness Beginner's?
*
Casual Waiver
To perform any exercise with us here at Feel Good Fitness Beginner's you must state any medical conditions above. Please read sign our casual waiver stating you understand and agree to the below terms and conditions.
By signing this disclaimer you understand that before you begin any exercise program, you should consult your physician about participating in the exercise program. Not all exercises are suitable for everyone. You understand that exercise may be a risk to your physical safety if not done properly. If you feel discomfort or pain, you should not continue. The instructions and advice presented are in no way intended as a substitute for medical advice. Having read this waiver and knowing these facts, and in consideration of Feel Good Fitness WA accepting your application, you waive and release Feel Good Fitness WA, its officers, directors, agents, representatives, licensors, employees,endorsers, distributors or dealers “the person” from all claims or liabilities of any kind arising out of my participation in this activity even though that liability may arise out of negligence or carelessness on the part of the persons or entities named in this waiver.
*
Clear
Emergency contact Name
*
First Name
Last Name
Emergency contact Phone Number
*
-
Area Code
Phone Number
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