Register for Classes Register for Classes Name* First Last Email* PhoneDate of Birth* MM slash DD slash YYYY Person to notify in case of emergency* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone number of emergency contact* Date of Last Physical MM slash DD slash YYYY Blood Pressure* * Do you have any injuries or health issues? If Yes, Please Explain*How did you hear about us?*WebsiteBbG ClassFriendList serveOtherPayment Options3 Month Unlimited Classes $3951 Month $135Pay Per Class $20Free ClassYou will complete payment after submitting this form.I agree to participate in the BbG Fitness Program and agree with the following Disclosure & Release. I agree to participate in a physical fitness program with Body by Ginny. I recognize that exercise is not without varying degrees of risk of injury including, but not limited to, muscoskelatal and/or cardio respitory systems. I hereby certify that I know of no medical problems (except those that I have disclosed previously) that would increase my risk of illness and/or injury as a result of my participation in a fitness program with Body by Ginny. I agree that if I become aware of any medical problems that might increase my chance of illness and/or risk of injury as a result of participation in a fitness program with BodybyGinny, I will notify my physician and BodybyGinny immediately. I acknowledge and agree that I understand and assume any and all risks and dangers relating to my participation in the BbG program. I hereby release, discharge, indemnify, hold harmless BodybyGinny from and against any and all injury, illness, harm, claims, demands, actions or damages of any kind or nature resulting from or in any way relating to my participation in the BbG exercise program. ** I agree Arlington County Hold Harmless AgreementIn consideration of my being granted permission to participate in these activities and to use the facilities of the County and/or other activities and services provided by the Arlington County Department of Parks, Recreation, and Cultural Resources, its agents and employees, including food service, I, on behalf of myself, my executor, administrators, heirs, next of kin, and successors, hereby covenant to hold harmless and indemnify the County and all its officers, departments, agencies, agents and employees from any and all claims,(except for claims based on malicious conduct by County officers and employees), lessees, damages, injuries, fines, penalties and costs (including court costs and attorney's fees), charges, liabilities, or exposures, however caused, resulting from or arising out of or in any way connected to me or my family's participation in the program. I have read and understand this HOLD HARMLESS AGREEMENT and agree to its terms. ** I agree Total $0.00 NameThis field is for validation purposes and should be left unchanged.