San Juan Island Fitness Club
“CHWC” REGISTRATION
Individual__________ Team of 2__________ Team Corporate__________
Team Name _________________________________________________________________
_____ Previous Challenger - $65 _____ Member - $75 _____ Nonmember – $75 |
_____ Option #1 – $100 member with 3-Presonal Program Plan _____ Option #2 – $300 non-member with pool and 3-Presonal Program Plan _____ Option #3 – $250 non-member with no pool and 3-Presonal Program Plan _____ Option #4 – $180 non-member 36 class punch card |
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Name___________________________________________________________________________________________
Age_____DOB___________________________________________________________________________________
Address_________________________________________________________________________________________
Phone___________________________________email____________________________________________________
Emergency Contact_________________________________________________________________________________
Allergies/Medical/Other conditions we should be aware of: ______________________________________________________________________________________________________
_____________________________________________________
Liability Release: “I, the undersigned, hereby certify that I am physically fit and have not been otherwise been informed by a physician. I acknowledge that I am aware of all the risks inherent in physical activities, including various injuries. I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES, INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE OF ISLAND ATHLETIC EVENTS, LLC dba SAN JUAN ISLAND FITNESS, HOST FACILITIES, OR ANY INDIVIDUALS VOLUNTEERING OR SUPERVISING SUCH ACTIVITIES. Finally, I specifically acknowledge that I am aware of all the risks inherent I agree that I won’t sue ISLAND ATHLETIC EVENTS, LLC dba SAN JUAN ISLAND FITNESS; it’s employees or agents for anything. My participation in the “Community Healthy Weight Challenge” is my decision and I hereby acknowledge my personal responsibility for my decisions and me. I understand there are no refunds for this event for any reason.
Signed______________________________________________________date_________________________
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