Healthy Living Group Registration form

PAID_______

Class Name­­­­­­­­­: the Cedars House Healthy Living Group

Class Start Date: Wednesday, January 4^th @ 7 pm

Class Length: 8 weeks

Cost: $185 (includes ½ hour personal training session)

Cash, credit, or check (to the Cedars House). Stop in or mail form to:

The Cedars House

c/o 700 Thomas Road

Philadelphia, PA 19118

Coach: Amanda Schlitzer

Name____________________________________________________________________________

Best phone______________________________________________________________________

e-mail____________________________________________________________________________

I the undersigned, intending to be legally bound, hereby, for myself, my heirs, executors administrators, and representatives waive and release any and all rights, claims and obligations of any kind for any damages of any kid that I may have against the Cedars House and its representatives or Fairmount Park for any and all injuries and/or losses suffered while participating in this class. I also waive any rights of subrogation by any party. Lastly, I will hold harmless the Cedars House and its representatives and Fairmount Park from any damages that I may have contributed to in any way. I attest that I am in good health and am able to participate in moderate to rigorous exercise. By signing below, I attest that I have read, understand and agree to all terms and conditions as listed in the above waiver.

Name (Signature) Date