Health & Wellness Program Enrollment Enter Member ID Participant First Name Participant Last Name Street Address City State Zip Email Home Phone Cell Phone Cell Phone Provider Date of Birth Gender School District Fitness LevelBeginnerIntermediateAdvanced I am physically able to participateYesNo Emergency Contact Relationship Street Address City State Email Home Phone Cell Phone Parent Guardian Contact (for children under 18) Relationship Street Address (if different than above) City State Zip Email Home Phone Cell Phone Which programs are you interested in? Fitness CenterPound Fitness ClassesZumba Fitness ClassesWater Aerobics I release HHI from any and all liabilities in the event of an injury to myself and/or child while at HHIYesNo I assume all risks and hazards incidental to participationYesNo I hereby waive, release, absolve, indemnify, and agree to hold harmless HHI, the organizers, all officers, directors, sponsors, supervisors, participants, volunteers, employees, agents, and instructors from any claim arising out of injury or accidentYesNo I and/or my child agree to participate in the HHI Fitness & Wellness Program under its facilities rules and regulationsYesNo I agree to allow the use digital pictures/recordings during fitness activities by HHI for promotional purposesYesNo reCAPTCHA helps prevent automated form spam.The submit button will be disabled until you complete the CAPTCHA.
