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FITNESS REGISTRATION FORM
Small Group Fitness Registration
Positional Training and Match FIT
Teams
Erin Mills G2006
Dixie SC – Angelica
CONTACT
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HOME
ABOUT
Our Company
Our Staff
F.A.Q
SERVICES
PHYSIOTHERAPY
Athletic Therapy
FITNESS / SPORT CONDITIONING
Nutrition (RD)
Consult Appointments
Follow-up Appointments
Nutrition (RD) Packages
Newsletters
Intramuscular Stimulation
VIDEOS
Ankle
Knee
Hip
Spine
Shoulder
PRODUCTS
OA Reaction Web
Custom Knee Brace
Cross Strap
OFFICE FORMS
PHYSIOTHERAPY INTAKE FORM
MASSAGE THERAPY INTAKE FORM
MOTOR VEHICLE ACCIDENT INTAKE FORM
WSIB INCIDENT FORM
DIETITIAN INTAKE FORM
Athletic Therapy Forms
VIRTUAL FITNESS MEMBERSHIP
FITNESS REGISTRATION FORM
Small Group Fitness Registration
Positional Training and Match FIT
Teams
Erin Mills G2006
Dixie SC – Angelica
CONTACT
Small Group Fitness Registration
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Small Group Fitness Registration
Name
*
Name
Phone
Date of Birth
*
MM slash DD slash YYYY
Day Phone
*
Cell Phone
Emergency Contact
*
Name
Phone
Email
*
Address
*
[Street #, Street Name, City, Postal Code]
I agree to release and waive all claims and hereby indemnify and hold harmless the Corporation of Competitive Edge Physiotherapy and Sport Conditioning (CE) and its elected officials, officers, employees, agents representatives, volunteers and other participants (“The Indemnified Persons”) for a any and all liability for any property damage or personal injury resulting to me or to any of the above-named person(s) for whom I am in law responsible, from or connected with participation in any activity contemplated by this Registration. I hereby further agree that CE and the Indemnified Persons shall not be liable, either directly or indirectly, for any claims, or damage, costs and expenses respecting any act done in good faith, including but not limited to personal injury, death, property damage or loss resulting from or connected with participation in any activity contemplated by this Registration. I have read and understood the Waiver of Liability
*
Yes
No
September Schedule
Tues 6-7pm ( Ages 9-12)
Tues 7-8pm ( Ages 13-16)
Thurs 6-7pm ( Ages 9-12)
Thurs 7-8pm ( Ages 13-16)
Saturday 9-10am (Ages 9-12)
Rate Options
Pay per session - $25.00 plus HST ($28.25)
8 sessions - $160.00 plus HST ($180.80)
*Payment must be received to confirm your spot. E-Transfer to i
[email protected]
or Credit card / Debit / Cash at First Session
0
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