Register for Zumba Ditch the workout and join our Zumba Fitness Party at ProFormance! Please fill out this form to register for Zumba Classes. Name*FirstLastAddress*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodeEmail*Phone*Date of Birth* ReferralComments/Questions *If using a Voucher, please indicate the Type and Number, otherwise, you can purchase a Zumba package in the store. Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. If you are planning to become much more physically active than you are now, start by answering the seven questions below. Common sense is the best guide when you answer these questions. Please read the questions carefully, answer each one honestly and read and sign the waiver below. 1. Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*YesNo2. Do you feel pain in your chest when you do physical activity?*YesNo3. In the past month, have you had chest pain when you were not doing physical activity?*YesNo4. Do you lose your balance because of dizziness or do you ever lose consciousness?*YesNo5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*YesNo6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?*YesNo7. Do you know of ANY OTHER REASON why you should not do physical activity?*YesNoI have volunteered to participate in a program of physical exercise under the direction of National Strength and Conditioning Association (NSCA), which will include, but may not be limited to, weight or resistance training. In consideration of the NSCA's agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless the demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting therefrom. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION. I recognize that exercise might be difficult or strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure, fainting, disorders in heartbeat, heart attack, and, in rare instances, death. I understand that as a result of my participation in an exercise program, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and may vary. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST PROFORMANCE FITNESS FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS. Name of Participant*Electronic Signature*Date UntitledOpt OutYou will automatically be added to our email database and receive fitness tips, videos and special discounts unless you click here to opt out.
