Fit over Fifty Registration for Winter 2018
YOU ARE REGISTERING FOR FIT OVER FIFTY Winter 2018 Session 2. ( 8-week session running from 3/12-5/3.)
PLEASE READ THE SELECTIONS CAREFULLY.
Monday morning is a new Fit over Fifty class. It will include floor work and will be a bit more challenging, however chairs will still be available. ALL LEVELS ARE WELCOME, as always, as modifications are always given.
*PLEASE FILL IN ALL FIELDS.
Cash or check made payable to Michelle Kellett is due on the first day of the session. Thank you!
Your name: *
Your answer
I am registering for: *
Your address: *
Your answer
Your date of birth: *
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Your email: *
Your answer
Best number to reach you: *
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Emergency contact name: *
Your answer
Emergency contact number: *
Your answer
If there are dates that you know you will be missing, UPON REGISTRATION, you may include those dates below and I will send you a pro-rated total for the class.
Your answer
and just a few words to describe your fitness level,..
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IF YOU WOULD LIKE TO TRY A FIT OVER FIFTY CLASS, 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. _______________________________________________
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