Encounter Wellness Fitness Class

First Name *

Last Name *

Email *

Cell Phone (I will add you to our group text list so I can inform you of any class changes/cancelations, I promise no spam & no reminder texts unless you opt in on that.) *

Would you like a reminder text about class the night before?

Yes

No, Thanks

Clear selection

Do you have any medical conditions we should be aware of? (Heart conditions, joint issues, asthma, injury, etc.) If not just answer "na." *

Are you pregnant? *

Yes

No

Name and number of emergency contact *