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Please fill out this registration form. We will contact you
shortly with confirmation if a space is available in the
timeslot you choose.
Or you may print
and mail this printer-friendly form.
Click Here |
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First
Name |
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Last
Name |
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Address |
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City,
State, Zip |
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Birthdate |
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Email |
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Work
Phone |
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Home
Phone |
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Cell
Phone |
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Emergency
Contact Name |
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Emergency
Contact Phone |
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Do
you have any medical issues we should be aware of? Previous
injuries?
Please describe below:
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Have
you taken Yoga, Pilates or Gyrokinesis® before? If
so, please indicate approximate dates, course levels,
instructor, equipment, etc...
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Stott Pilates Course Selection: (Enter your preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Gyrokinesis® Course Selection: (Enter your
preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Yoga
Course Selection: (Enter your preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Yamuna® Body Rolling Course Selection: (Enter your preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Cardiolates® Course Selection: (Enter your preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Jazz Hip-Hop Selection: (Enter your preference) |
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First
Choice: |
Day Of
Week:
Time of Day: |
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Please mail a check payable to "Shelia Donovan"
Due to limited space, your class reservation is not
confirmed until we receive your payment.
We will not be making phone calls to confirm your class schedule.
Please include an email address for communication purposes.
An email confirmation will be sent to you when we receive your payment. |
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