WARNING - Waiver Has Not Been Signed - Please confirm this action
Where did you hear about our Program?
Adult Punch Card Tuition:
Tuition is for 11 punch 90 minute classes.
Payments must be made by CASH, VISA, MASTERCARD, or AMERICAN EXPRESS.
A $25.00 LATE fee will be applied to all accounts not current after the 5th of the month.
Credit Card Type:
Punch Card Tuition:
Participant Signature (18 years and older)
PERMISSION FOR MEDICAL TREATMENT
I confirm that the above named person is in good health. I authorize simple First Aid and consent to
medical treatment by a physician if deemed necessary.
Must sign the back of this form to be on the gym floor!