Client Information Name * First Name Last Name Date of Birth MM DD YYYY Additional Notes (Allergies, health issues, etc.) Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name: Emergency Contact Mobile Number * (###) ### #### Emergency Contact Home Number (###) ### #### Email * E-Newsletter Please check this box if you would like to receive our golf e-newsletter with program information, upcoming events and promotions. Liability Waiver * I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity. Having such knowledge, I hereby acknowledge this release, any representatives, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, ailments or impairments which may affect my ability to participate in said fitness program. Date * MM DD YYYY Thank you!
