Zumba Get Fit • Zumba® & Zumba Toning® Registration and Participation Waiver
Please fill this form out prior to coming to your first class. If you have any problem viewing or submitting this form, please contact me: annette@zumbagetfit.com or 203.441.3177. I will have forms available for filling out in class as well, but to speed up the signing in time, I'd ask you to fill this out prior to your first class.
Your Full Name *
First and Last Name
Your answer
Your Date of Birth *
Your answer
Your Email Address *
Please provide your email address that you check frequently in case of class schedule changes, promotions etc that will be emailed in newsletters to you.
Your answer
Your Phone Numbers *
Please provide your cell phone and the best number to reach you if other than cell phone number
Your answer
Are there any special needs/ medical concerns? *
Please explain, if any.
Your answer
Emergency Contact *
Please provide your emergency contact name and phone number.
Your answer
How did you hear about Zumba Get Fit classes? *
If referred by a friend please provide the name so they may receive credit for the referral.
Your answer
Zumba Get Fit Liability Waiver

1. I am participating in ZUMBA© or ZUMBA TONING© Classes offered by Annette Kokkola-McLean. I recognize that ZUMBA© and ZUMBA TONING© require physical exertionthat may be strenuous and may cause physical injury. I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the ZUMBA© or ZUMBA TONING© classes. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in the ZUMBA© or ZUMBA TONING© classes.

3. In consideration of being permitted to particpate in the ZUMBA© and ZUMBA TONING© classes, I knowingly voluntarily and expressly waive any claim I may have against Annette Kokkola-McLean for damages, and injury, including death, that I may sustain as a result of participating in ZUMBA© or ZUMBA TONING© classes.

Your Signature and Date *
Please sign- type your full name and Date: Month/Day/Year
Your answer
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