The Healthy Church Tour - The Life Center Fitness

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Email:

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

Healthy Church Tour - Registration

Contact Information

Health Information