Healthy Church Tour - Registration
	Contact Information
	First Name:
	Last Name:
	Address 1:
	Address 2:
	City:
	State:
	Zip:
	Phone:
	Email:
	Health Information
	Age:
	Height:
	Weight:
	When was your last doctor visit?
	Do you have high blood pressure?	Yes | No
	Do you have low blood pressure?	Yes | No
	Do you have high cholesterol?	Yes | No
	Do you have Asthma?	Yes | No
	Do you have Diabetes?	Yes | No
	Do you have any issues with your:	Back  Hips  Knees  Shoulders
	Do you have any limiting physical conditions?	Yes | No If yes:
	Has your doctor released you to work out?	Yes | No
	Does your doctor encourage you to work out?	Yes | No
	Are you interested in participating in the “Healthy Church” Tour?	Yes | No
	What Classes Are You Interested In?	Obstacle Course Cardio Kick-Boxing Jazz Dance Yoga Sculpt Boot Camp Seated Aerobics Zumba Cardio/Sculpt Dance Party with Lazet
	Registration Fees:	$50
	1 Corinthians 6:20 "For you are bought with a price: therefore glorify God in your body, and in your spirit, which are God's".
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