Online Application Form Selected TrainingVIRTUAL PRIVATE TRAININGVIRTUAL GROUP TRAININGPlease fill the following form and send us by pressing Submit Button. We will get in touch with you. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Cell Phone*Home PhoneHeightWeightAge Do you have any issues with your shoulders, back, knees or hips?Do you have any issues with your shoulders, back, knees or hips?NoYesIf Yes State Details Do you have high or low blood pressure or any other issue we need to know about?Do you have high or low blood pressure or any other issue we need to know about?NoYesIf Yes State Details Asthma?NoYesDiabetes?NoYesHave you had joint problems or injuries in the past?NoYesWhat are your fitness goals?Goal weight? Life Center Private Fitness Waiver I have joined the Life Center Online Training. I have enrolled in a program of strenuous physical activity including but not limited to, aerobic dance, walking, running, jumping, weight training, functional training offered by Lazet Pelzer and instructors at the Life Center Private Fitness in person or online. I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this exercise program online or in person. In consideration of my participation with Lazet Pelzer or any Life Center instructor and the Life Center Private Fitness aka Life Package center I for myself, my heirs, and assigns, hereby release Lazet Pelzer and the Life Center Private Fitness from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls or tears, broken bones, shin splits , heat prostration, knee, back, foot injuries, and any other illness, soreness, or injury, however caused occurring during or after my participation in the exercise program online or in person.Click to Accept By clicking this I hereby affirm that I have read, fully understand and agree to the above.