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
Date:
Your answer
Name (Last, First) *
Your answer
Children's name(s) if they will be taking a class
Your answer
Address, City, State, Zip Code *
Your answer
Phone Number: *
Your answer
Email:
Your answer
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.
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): *
Your answer
Phone Number: *
Your answer
Relation to You (Mother, Spouse, Close Friend): *
Your answer
How long has it been since you have participated in a regular exercise program?
Your answer
Do you have any existing health conditions that may restrict your ability to participate in exercise? *
If yes, please briefly explain:
Your answer
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?
What are your fitness/wellness goals?
Your answer
How did you hear about Source Studio?
(Check any that applies)
What social media networks do you use?
Make sure to follow us @SourceStudioCA :)
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