Fitness Registration Form - Fallon County Recreation Department

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Fitness Registration Form
Fallon County Recreation Department
Name(please print):
Date:
Address:
City:
Zip:
Email:
Daytime Phone:
Alternate Phone:
Refund Policy: No refunds will be given once a program has begun. No discounts will be given for ab-
sences.
Notice to all participants and parents: By my signature below, I acknowledge that physical activities
create inherent risks of injury to my person. I, hereby, assume these risks, waive and release the Fallon Coun-
ty Recreation Department, the City of Baker, Fallon County, Baker Schools, and those associated from any
and all rights and claims for damages or other loss which might suffer while participating in Fallon County
Recreation sponsored physical activities or as a result of my use of the equipment or facilities. I the partici-
pant/parent, completely agree and will not hold any of the before mentioned entities liable for any injuries or
damages both known and unknown whatsoever. If the participant is under the age of 18 years, a parent or
legal guardian must sign below to release your child to participate.
PARTICIPANT/GUARDIAN SIGNATURE___________________________________________DATE_______________
Class Guidelines
Location: The majority of classes will be held in the Fitness Room at the Baker Recreation Center. This room is locat-
ed at the end of the hall on the left, across from the weight room.
Registration/Fees: Registration must be completed for each participant. Forms are available on-line or from the
class instructor. Fees may be paid to the class instructor or mailed to the Rec Dept.
Class Sign-in: Please remember to sign-in on the attendance sheet for each class. Please sign only for yourself, as
this is our only proof of attendance.
Equipment: Most equipment is available at the Recreation Center. Items that you will need to bring are designated
indoor workout shoes, and an exercise mat. Please be courteous and wipe down equipment before you put it away.
Children: Children are not allowed to attend scheduled adult fitness classes.
Please fill out the information below:
Your personal fitness goals:
How the instructors can help you obtain your goals:
What helps to keep you motivated to continue to attend our fitness classes:
What time of day is most convenient for you to exercise?
Please list fitness class(es) that you are interested in taking:
Any classes that you would like us to offer in the future:

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