Your Information

And Personal Fitness

Please Fill out the Following form.

Contact Information





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Address


Date of Birth: (MM/DD/YYYY)
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Address


On going classes

Check out Scheduled Class timesa and prices.

  

Visit our site for PRICEShttp://anesteaservices.weebly.com/ 

Anestea Services



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Member

Each member of your Group needs to Fill out an Information/ Registration from.

Each Member of your Group needs to Fill in the The Same Group name.


Non-Member

Each member of your Group needs to Fill out an Information/ Registration from.

Each Member of your Group needs to Fill in the The Same Group name.


Day and Time:






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Type/ Style:




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Type:




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Waiver

Release:

I hereby consent to participate in activities offered by Anestea Services; Angela L. Carmichael. 

 

It is hereby agreed that I and/or my children waive and release all right and claims for damages that I and/or my children may have at any time against  Anestea Services, Angela L. Carmichael, and/or any associated representatives whether paid or volunteer; for any injury of damages in connection with any and all programs or other activities related to the programs offered. 

 

The risks involved in respect to such a program are fully understood.

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Permission for Medical Treatment:

I confirm that the previously named person is in good health unless indicated below.  I hereby authorize simple first aid.

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By typing you First and Last name here you acknowledge that all the information given in correct to the best of your knowledge and you agree to the waver conditions as indicated.

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