Class registration
Welcome to our Empowered By Movement community! We ask that all participants provide us with the following information to register for classes. Registration is only needed once and provides access to all future classes.

We are glad you're here. Let's move!

For additional information on our classes please visit: https://empoweredbymovement.org/hybrid-classes/
In Google anmelden, um den Fortschritt zu speichern. Weitere Informationen
E-Mail-Adresse *
Today's date: *
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Participant name (First, Last) *
Address (Street, City, State, Zip) *
Phone *
Birthdate *
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How did you hear about us? *
Please check all that apply.
Pflichtfrage
Please tell us about yourself. *
Please check all that apply.
Pflichtfrage
Is there anything else you'd like to share with us?
When will you be joining us? *
Please check all that apply.
Pflichtfrage
Emergency Contact (First, Last name) *
Emergency Contact (Relationship) *
Emergency Contact (Phone) *
Purchase options *
No payment will be collected or processed until after your trial period. Monthly cost Includes unlimited classes and access to our Move on Demand video library.
Payment options *
LIABILITY:  This agreement releases Empowered By Movement Corporation from all liability relating to injuries that may occur. By signing this agreement, I agree to hold Empowered By Movement Corporation entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in movement. These include but are not limited to sprains, bruises and fractures. By signing below, I forfeit all right to bring a suit against Empowered By Movement Corporation for any reason. I will also make every effort to obey safety precautions and as explained to me verbally. I will ask for clarification when needed. *
IMAGE CONSENT:  I hereby grant Empowered By Movement Corporation permission to capture my image and likeness, in photographs, videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that Empowered By Movement Corporation will own such Images and further grant Empowered By Movement Corporation permission to copyright, display, publish, use, modify, print and reprint such Images in any manner whatsoever related to Empowered By Movement Corporation business, training, and research, including without limitation, publications, advertisements, brochures, web site images, training workshops, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by Empowered By Movement Corporation prior to its use. I forever release and hold Empowered By Movement Corporation harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity. I understand that my name will never be used in association with any such Images whatsoever. *
COVID policies: Your safety is our top concern. The instructor will be sharing precautionary measures for any par that join us in-person. We ask that in consideration of others that you comply with the efforts that we are taking to keep our participants, teachers and volunteers safe. *
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