Wellesley Fitness Registration
Registration for Spring Classes, Tuesdays and Thursdays from 8:30-9:15pm at the Wellesley Mennonite Church. There are a few options for signing up, check them out below!
Participant's Name
*
First Name
Last Name
Participant's Email
*
example@example.com
Participant's Phone Number
*
Please enter a valid phone number.
Emergency Contact Person
*
First Name
Last Name
Emergency Person's Phone Number
*
Please enter a valid phone number.
Class Selection
*
March 21 - May 4: One class/week ($55)
March 21 - May 4: Two classes/week ($100)
March 21 - June 22: One class/week ($110)
March 21 - June 22: Two classes/week ($205)
Class Payment
*
E-Transfer to wellesleytkd@gmail.com before March 21, 2023.
Participation Questionaire
If you answer yes to any of these questions, it is recommended that you consult a physician before substantially increasing your physical activity.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
Do you have any injuries or limitations that you would like me to know about?
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform