CAMP & CLASS REGISTRATION Please fill out this registration form as complete as possible and submit with payment to: ACE-FIT 13403 W 139th Terr Overland Park KS 66221 Phone: 913-209-2690 Email: skyler1@kc.rr.com 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 ACE-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 ACE-FIT camp or program.

LIABILITY & MEDICAL RELEASE:

In consideration of participation in ACE-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 ACE-FIT, owner Skyler Ricard, 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 ACE-FIT to seek medical treatment in the event of an accident or emergency.  With your request to participate in an ACE-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