Source Studio Member Information
Thank you for taking the time to complete this form! Source Studio is always looking to provide a better and safer environment for all students :) The information provided in this information form is only available to Source studio management and never be sold to any third parties.
General Contact Information
Name (Last, First)
Children's name(s) if they will be taking a class
Address, City, State, Zip Code
Do you wish to be added to our monthly newsletter and birthday list for gift certificates?
We do not share your email with third parties.
No thank you!
Emergency Contact Information
Source Studio strongly suggests each participant consult with a medical physician prior to partaking in any new physical exercise program.
Contact Name (First, Last):
Relation to You (Mother, Spouse, Close Friend):
How long has it been since you have participated in a regular exercise program?
Do you have any existing health conditions that may restrict your ability to participate in exercise?
If yes, please briefly explain:
Nice to Meet You!
They us your goals and interests when it comes to your well-being :)
What classes are you interested in taking/learning more about?
Tribal Belly Dance
Zumba for Kids
RIPPED Cardio Core Fitness
What are your fitness/wellness goals?
How did you hear about Source Studio?
(Check any that applies)
Social Media (Facebook, Twitter, Instagram, Tumblr, Pinterest)
Reference (Source member, Friend, Teacher)
Web search (Google, Bing, Yahoo)
Drove past the studio
What social media networks do you use?
Make sure to follow us @SourceStudioCA :)
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