siHi Spring Registration

siHi Spring Schedule

7:30-9:30 pm

Thursdays: April 27th - June 29th
HB YMCA: 8875 Adams Ave. HB, Ca 92646

Registration

Registration ($65.00) [Sold Out]

Name

Phone Number

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Address

Do you exercise?

If so, how often and what type of exercise?

Are you taking any medication? Please list.

Do you have any physical limitations, injuries?

Physician name and number.

Emergency contact name and number

Goals: What do you hope to take away from your 10-week journey?

Date of Birth

Gender

Male
Female

Convenience Fee

$0.00

Running Total

$0.00

Coupon Code

Total

$0.00

siHi Commitment and Waiver

I, the undersigned, agree to the terms above.

siHi Photo Consent

I, the undersigned, agree to the terms above.

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

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