Wholy Fit Registration

Name: *

Street Address:

Phone Number: *

Email: *

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Number: *

List any medical conditions or concerns of which your instructor should be aware:

Number of sessions per week: *

Indicate probable class days/times you will attend:

Tuesdays 5:30 pm

How did you hear about Wholy Fit classes:

Form of Payment: *

If paying by Credit Card or Paypal, an email will be sent with a link to proceed with your payment within 24 hours.

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