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Let's Get Started!

Please fill out this form to tell me a bit about yourself and your training goals.

Name

First Name

Last Name

Email Address

Cell Phone (Please include best time to reach you)

Age, type of occupation/lifestyle (ex: desk job or always on the run?)

Fitness history? What type of sports/physical activities have you practiced? What do you currently practice?

Please list any injuries (past and present) including any chronic pains or conditions and any recent surgeries:

How did you hear about Erika?

What are your training goals? Is there anything you would like to focus on in particular? Strengthening? Pain relief? Flexibility or athletic performance?

Please list all MEDICAL CONDITIONS (including pregnancy) and all ALLERGIES that should be made known to medical personnel in the event of an emergency.

Checkbox

Waiver

I certify to be in proper physical condition to participate in training with Erika Vipond. I will inform the trainer, Erika Vipond, of any specific physical conditions that I may have. I agree that Erika Vipond, her officers, employees and agents shall not be liable for any claim, demand or cause of action of any kind resulting from or related to the use of the facilities or participation in any sport, exercise or activity within the club/studio premises. I accept that neither the instructor nor the host facilities are liable for theft and or loss of personal effects or damages to property, resulting from taking this class. Finally, I release Erika Vipond and the host facility from all liability for injuries or physical problems.

Emergency Contact (Name, relationship and cell number)

Let's Get Started!

Thank you! I will be in touch within 48 business hours to schedule a session.