Minor Waiver Form – Fitness Lounge

Please Select Facility

Steinway Location (30-77 Steinway Str, LIC, NY)
31st Str. Location (2579 31st Str, LIC, NY)
UES 88th (1695 1st Ave., NY, NY)
Gramercy (291 3rd Ave., NY, NY)

Full Name of Minor

First

Last

Full Name of Parent/Guardian

First

Last

Email of Parent/Guardian

Phone of Parent/Guardian

Trainer/Instructor/Therapist Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

List any Medical/Health Conditions of Minor

Please Read and Agree to the Following;

I Have Read and Agree to the Minor Training & Therapy Services Waiver and Release
I Have Read and Agree to the Privacy Policy