Adult Training Waiver Form – Fitness Lounge

Please Select Location

Steinway (3077 Steinway Str., LIC, NY)
31st (2579 31st Str., LIC, NY)
UES 88th (1695 1st, NY, NY)
Gramercy (291 3rd Ave., NY, NY)

Full Name

First

Last

Email

Phone Number

Trainer/Instructor/Therapist Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

List any Medical/Health Conditions

Emergency Contact Full Name

First

Last

Emergency Contact Number

Checkboxes

I am over the age of 18
I Have Read and Agree to the Adult Training & Therapy Services Waiver and Release
I Have Read and Agree to the Privacy Policy