Registration

1. Personal Information 2. Health Questionnaire 3. Pick a Membership

Health Questionnaire
Date of Birth (d/m/y):
Gender (M/F):	Weight (pounds):	Height (feet/inches):
What are your personal goals? (check all that apply) To Lose Weight. How much? To Lose Inches How many? Tone up and enhance muscle definition Gain strength or muscle endurance Maintain current weight and muscle tone Increase stamina and cardiovascular performance
Are you currently physically active? No Yes, 1-2 days a week Yes, 3-4 days a week Yes, 4-7 days a week What type of exercise? How many hours per week are you realistically willing to devote to exercising? Medical History (check all that apply) Suffer from back pain Currently pregnant High blood pressure Recently had surgery Have arthritis Have joint restrictions. Please explain: Was advised by a physician to avoid types of exercise. Please explain:
Fitness Equipment: Select ALL equipment that you either own, have access to, or will be receiving from us. Resistance bands with handles (Xertubes) Resistance Loops (Xering/Ultra Toner) Stability Ball Weights Bosu Jump Rope Foam Roll Mat Xerdisc/Dynadisc I plan to purchase equipment from your store.
Release of Liability >> View Release of Liability Do you agree to the Release of Liability terms as detailed? Yes, I agree No, I don't agree By choosing 'Yes' you are indicating that you have read the Release of Liability above, fully understand and accept its terms and that you have given up substantial rights by accepting these terms.
Membership Agreement and Terms of Use >> View Membership Agreement and Terms of Use Do you agree to the Membership Agreement and Terms of Use as detailed? Yes, I agree No, I don't agree By choosing 'Yes' you are indicating that you have read the Membership Agreement and Terms of Use above and fully understand and accept its terms.