CAMP & CLASS REGISTRATION

Please fill out this registration form as complete as possible and submit with payment to:

TiF-FiT
14920 W Peppermill Dr.
Olathe KS 66062                                              Phone: 913-209-2690

Date: ______________________
Personal Information
Name  
Phone, Day  
Phone, Evening  
Address
 		 Street:

City:                                  State:          Zip:
Email  
Preferd Contact Day Phone /  Evening Phone /  Email
Gender Male    /    Female
Date of Birth  
Shirt Size  
Emergency Contact 1
Name  
Phone  

Emergency Contact 2
Name  
Phone  

Medical Contact
Clinic/Physician  
Phone  
Camp & Class Information
Program   Start Date  
Session   Fee  
Please list some of your main Health/Fitness Goals.


 
What have been your obstacles in the past staying with a Fitness Program? (example: medical, family, lack of support, boredom, etc.)


 
Refunds will not be issued after acceptance of registration.  If TiF-FiT cancels a program due to limited registration, a full refund will be issued within two to three weeks.  Completion of the registration form is required before attending any TiF-FiT camp or program.

LIABILITY & MEDICAL RELEASE:
In consideration of participation in TiF-FiT activity, participants, parents and/or guardians acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release TiF-FiT, owner Tiffany Jenks, and its trainers/instructors from liability for any and all claim for personal injuries, including injuries that arise from the negligence of someone other than the participant.  Participants, and or parents/guardians of a registered minor, authorize trainers/instructors of TiF-FiT to seek medical treatment in the event of an accident or emergency.  With your request to participate in a TiF-FiT program, we request that you ask your doctor’s advice if you have a history of heart trouble, diabetes, high blood pressure, or other medical problems prior to participation in an exercise program.  We also suggest that you have a physical examination performed by your doctor prior to increasing physical activity and participation in an exercise program.

REQUIRED SIGNATURE:________________________________________________  DATE: ___________________
(PARTISIPANT 18 OR OLDER OR PARENT/GARDIAN IF UNDER 18)

Applicant Accepted:
Weeks: Session Dates:
FEE   PAID   REMAINING