2019 St. Joe Fit Registration
Please complete all questions completely to register for the 2018 St. Joe Fit Program. One registration form per person participating required. This is a free fitness program sponsored by the St. Joseph Health Department, The REC Center, the YMCA and the St. Joseph Parks, Recreation & Civic Facilities Department. For any questions, please contact
or call Julie Noel at (816) 271-5516.
House Number and Street Name
Cell Phone Number
Home Phone Number
How do you prefer to be contacted?
I plan to participate in:
St. Joe Fit Walking Program
Aqua Fitness (if offered)
Fitness classes (if offered)
walking and aqua fitness (if offered)
walking and fitness classes (if offered)
aqua fitness (if offered) and fitness classes (if offered)
walking, aqua fitness (if offered) and fitness classes (if offered)
How did you hear about St. Joe FIT?
Participated in 2018 or before
Age (optional - used as demographic information for grant applications)
71 years or older
Gender (optional - used as demographic information for grant applications)
Household Income (optional - used as demographic information for grant applications)
less than $20,000
Waiver: Applications not accepted unless waiver is signed. In consideration of this entry, I the undersigned, intending to be legally bound, my heirs, executors. and administrators, waive and release any and all rights and claims for damages I may have against the City of St. Joseph, MO, any and all sponsors, partners, and volunteer workers and their representatives, successors, and assigns for any and all injuries suffered by me in said event. I realize this is a strenuous physical activity, taxing all major components of the body and I attest and verify that I am physically fit, have sufficiently trained for the completion of this event, and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use any photography, videotapes, motion pictures, recordings, or any other record of this event for any purpose whatsoever.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service