2571 PICTON

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DROP-IN / CASUAL

Membership Terms

Expires After: 1 year(s)

Attendance: 1 class

Begin Date: 05/05/2024

End Date: 05/05/2025

Payment Terms

Price: $30.00

Autopay:ON

This membership is set to run on autopay.
All bills will be deducted automatically from the assigned account on the bill due date.

Due Now
First Installment	$30.00

My Personal Info

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First Name

Last Name

Date of Birth

Email Address

Home Address

Gender Identity

Emergency Contact Name

Emergency Contact Number

Have you knowingly suffered from any medical conditions in the list below

Are you over 45 and unaccustomed to exercise?

Yes No

Do you have any major injuries?

Yes No

Are you pregnant?

Yes No

Do you have any conditions that may limit your activity?

Yes No

Do you drink alcohol regularly?

Yes No

Do you smoke regularly?

Yes No

Are you taking any non-prescription medications?

Yes No

If you answered yes to any of the above, please tell us more here

Is there anything else you feel we should know about or are there any injuries or medical conditions

Are you presently Exercising?

Yes No

How many times a week do you train?

On a scale of 1-10 how hard do you work when you train?

What are 2 or more results you want to achieve through exercise?

When would you like to achieve these results?

Is there anything else you would like to tell us?

Do you currently attend a CrossFit Box?

If yes, which CrossFit Box do you attend?

How Did You Hear About Us?

2571 PICTON

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