Download Current Registration form

Name: ___________________________________Address: _________________________________
City/State:________________________________Phone: (H): ____________________ (C): ________________
Email: __________________________ Best way to contact you: __________________Date of Birth: _____________
Emergency Contact: ___________________ Emergency Contact Phone: ___________
*FOR MORE INFORMATION, call Sharon at 703.796.9282, or visit www.risingsunfitness.com MAIL COMPLETED FORM ALONG
WITH CHECK MADE OUT TO RISING SUN FITNESS, LLC.
PERSONAL TRAINING:
One on One
Partner Option(pp)
Single training sessions (60 min):
$80
$45
10 training sessions:
$750
$400
Single training sessions (45 min):
$65
$40
10 (45 min) training session:
$650
$30
10 (30 min) training sessions:
$500
Exercise/Lifestyle Consultation:
$90
--GROUP TRAINING PRICES: Hour sessions, prices listed below are per person.
PLEASE MAKE ALL CHECKS PAYABLE TO: RISING SUN FITNESS, LLC:
In Home(single/partner)
$95/$55
$900/$400
$85
$850
$675
ONLINE COACHING: Triathlon and single sport coaching. Tri coaching $175/month, single sport is 125/month (runners, cyclists).
Bootcamp $400/$200 ____
Track $120 ___ Barre/bend $90 ___ Yoga: Sundays 120 ___ Wednesdays 180 ___ Thursdays 180 ___
Health Risk Appraisal Questions: Please write YES/NO- do NOT leave blank,thank you.
Do you now, or have you had in the past:
Chest Pain ____________________
Asthma _____________________Heart Attack ______________________
Bursitis _____________________
Heart Disease _______________Arthritis ____________________
Pacemaker _____________________ Tendonitis __________________ High Blood Pressure (140/90) _______
Muscle Injury ________________
Diabetes ____________________Joint Injury _________________
Cancer __________________________Smoking ___________________ Pregnant/Postpartum ________________
Dizziness ___________________
Depression __________________Osteoporosis ________________
Low Back Pain ____________________High Cholesterol _____________ Nutrition Related Disorder ____________
List medications that you are currently taking on back.
Participant Assumption of Risk: I understand that participation in any physical activity involves inherent risks and that even when
safety precautions are utilized injuries can occur. I also understand that if I experience unusual pain or physical discomfort during
participation in any activity, I will decrease or stop exercising and inform my personal trainer of my symptoms. I am aware that
personal health/accident insurance is my responsibility. I claim that to the best of my knowledge, I do not have any medical or physical
disability that will preclude my safe participation in this program. I have completely read, understand and agree with the above form.
I release Rising Sun Fitness, LLC and all class facilities from liability.
Signature: _________________________________ Date: __________________