Workout on the Hill Registration for New Participants
Before you register for the first time, please fill out the
Physical Activity Readiness Form (PAR-Q Form)
All Fields noted with a (
*
) are Required!
Name
*
:
Email Address
*
:
Home address
*
:
City
*
:
State
*
:
Zip
*
:
Home Phone
*
:
Work Phone:
Mobile Phone:
Birth Date
*
:
In case of emergency, please contact:
Name
*
:
Phone
*
:
Do you have your doctor’s approval to exercise?
*
Yes
No
What is the present state of your general health?
*
Poor
Fair
Good
Very Good
Please rate your general level of physical fitness:
*
Poor
Fair
Good
Very Good
I am participating in the workout at:
*
6:15AM - 7:15AM - Monday - Wednesday - Friday
9:00 AM - 10:00AM - Monday - Wednesday - Friday
How did you learn about Workout on the Hill?
New Bernal Journal
Craig's List
Flyer
Referral
Other
Payment
*
I am registering with a check
I am registering with PayPal
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