About
Health Coaching
Aqua Fitness
Services
1 on 1/Online Training
Registration
Aqua Fitness Registration Form
Consultation/Registration Form
Health Coaching Program Registration Form
BOOKINGS
About
Health Coaching
Aqua Fitness
Services
1 on 1/Online Training
Registration
Aqua Fitness Registration Form
Consultation/Registration Form
Health Coaching Program Registration Form
BOOKINGS
Aqua Fitness Registration Form
Chetwayo's Aqua Splash
Registration Form
Name
*
First Name
Last Name
Email Address
*
Date of Birth
*
MM
DD
YYYY
Age
*
Sex
*
Male
Female
Other
Address
*
Phone
*
e.g. +1 868 123 4567
Country
(###)
###
####
Name of Emergency Contact
*
Relationship to Emergency Contact
*
Emergency Contact Phone
*
e.g. +1 868 123 4567
Country
(###)
###
####
Occupation
What conditions? (if any)
*
Please select the check box, if you have been or are currently suffering from any of the following conditions:
Allergies
Bad Knees
Injury from accident
Joint Problems
Recent birth
Arthritis/Bursitis
Diabetes
Lung disease
Pregnant
Resting heart-rate
Asthma
Heart Disease
Recent surgery
Back Problems
High blood pressure
Orthopedic problems
Recent hospitalization
None
Are you under any medication that the instructor or staff should be aware of? Please mention below:
*
Please state your covid 19 vaccine status, brand and number of doses.
*
Physicians Name
*
Physicians Phone Number
*
Class Location
*
The Well Fun Park, Cunupia
Fun Splash Water Park, Debe
How did you learn of Chetwayo's Fitness Enterprise?
*
TV
Radio
Social Media ads
Newspaper ads
Friend/Family
Other
Disclaimer
*
The disclaimer is listed in the yellow button below.
I agree that I have read and understand the contents of the Disclaimer stated on this website.
Today's Date
*
MM
DD
YYYY
Thank you for registering for Chetwayo’s Aqua Classes!
IMPORTANT DISCLAIMER
*Credit Card/ Online Payment Available*
