Free Class (First Time Boot Campers Only)

Name*

FirstLast

Email*

Address*

Street AddressAddress Line 2CityProvincePostal Code

Primary Phone*

Secondary Phone

Date of Birth*

Physician's Name

Emergency Contact*

Emergency Contact's Phone*

Please state which class (date and time) you will be attending*

Medical Concerns

Due Date (if registering for prenatal fitness)

Baby's Name (if registering for prenatal fitness)

Baby's Birthday (if registering for postnatal fitness)

Baby's Age (if registering for postnatal fitness)

Please enter a value between 0 and 10.

How Did You Hear About The Class?*

What Are Some Of Your Health and Fitness Goals?

Questions or Comments?

PAR Q #1: Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*

Yes
No

PAR Q #2: Do you feel pain in your chest when you do physical activity?*

Yes
No

PAR Q#3: In the past month, have you had chest pain when you were not doing physical activity?*

Yes
No

PAR Q #4: Do you lose your balance because of dizziness or do you ever lose consciousness?*

Yes
No

PAR Q #5: Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*

Yes
No

PAR Q #6: Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*

Yes
No

PAR Q #7: Do you know of any other reason why you should not do physical activity?*

Yes
No

IMPORTANT: I have carefully read and understood the Informed Consent, Waiver, and Release Agreement and I agree to the terms and conditions of the Informed Consent, Waiver, and Release Agreement. I understand that waiving certain legal rights by agreeing to the terms and conditions of the Informed Consent.*

I accept

If I answered 'yes' to any of the PAR Q questions, or am pregnant, I understand that I am required to get my doctor's approval for exercise prior to beginning the class.*

I accept

I understand that it is my responsibility to make each class. Missed classes cannot be made up in a following session and refunds for missed classes will not be given, unless special arrangements have been made prior to the start of the session.*

I accept

I have read and understand the cancellation policy and money back guarantee (on the FAQ page)*

I accept

I understand that any picture taken with Ascend Fitness is the property of Ascend Fitness and can be used at the discretion of Ascend Fitness. If I do not wish for my photo to be used, I will notify Ascend Fitness Coaching upon class registration.*