Fit over Fifty Registration for Summer 2019
YOU ARE REGISTERING FOR FIT OVER FIFTY Summer session running for 6 weeks, 7/16-8/22. * Please note that our times have changed for this 6-week session due to sharing of the space with the Summer Rec. Program.
VENMO, cash or check made payable to Michelle Kellett is due on the first day of the session. Thank you!
***NEW CLASS PARTICIPANTS: Please fill in all fields. Thank you! ***
I am registering for:
Tuesday/Thursday mornings; 8-8:50. Cost of this session is $78.00 (12 classes) 7/16,7/18,7/23, 7/25, 7/30, 8/1, 8/6, 8/8, 8/13, 8/15, 8/20, 8/22.
Your date of birth:
Best number to reach you:
Emergency contact name:
Emergency contact number:
If there are dates that you know you will be missing, UPON REGISTRATION, you may include those dates AND your new pro-rated total below. (classes are $6.50/each). Thank you.
How did you hear about Fit over Fifty?
and just a few words to describe your fitness level,..
Please take a moment to read this waiver, it must be signed and submitted prior to participation: I have agreed to participate in the Fit over Fifty fitness program with Michelle Kellett, being held at the Sodus Point, NY Community Center. I recognize that the program involves physical activity including, but not limited to, strength training, balance challenges, cardiovascular activities and flexible training. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I will notify Michelle Kellett of any such issues, in writing, prior to participation and will submit a medical release form prior to participating, if necessary. I acknowledge that my registration and subsequent participation in Fit over Fifty is voluntary. In consideration of my participation in this program, I hereby release and discharge Michelle Kellett from any claims, demands and causes of action as a result of my voluntary participation and registration in this class. I hereby waive and release all rights to photography and video taken by or for Michelle Kellett during the program. Any photos or videos taken by or for Michelle Kellett are sole property of Michelle Kellett and can be used in any advertisements, marketing or publications used to promote any program offered by Michelle Kellett. Registration is required prior to participation. Payment is due at time of registration. If you request a refund in writing within 24 hours of your registration, you will be entitled to a full refund, ( less 15% administration fees, if applicable). After the 24 hour grace period, all fees are non-refundable, and non-transferable. By checking the box below, you agree to all terms listed in this agreement. _______________________________________________
Yes, I agree.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service