Outdoor Class Register

You must register to attend outdoor classes at Renzie Park.

REGISTER FOR CLASS

Be advised there is always a risk of injury when engaging in a physical exercise program. If you have been treated or are currently being treated by a physician for any health condition(s) and/or if you have not had a physical exam in more than a year it is highly recommended that you seek approval from your physician before engaging in any exercise program.

IMPORTANT PLEASE NOTE:
This class is a high intensity interval class and may not be suitable for those who just started an exercise program less than 2 months ago. If you are currently nursing a body injury, please contact Dana to be sure this type of class will be suitable for your current condition. Email: dsandmeyer@comcast.net or Cell/Text: 412-999-6984

After registering you will be taken to the online payment page.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Is this a cell? *

May I text you regarding class cancellations? *

Emergency Contact Name *

Emergency Phone Number *

Please answer the following questions. You are not asked to provide the trainer with the answers to these questions for registration. However, to ensure your safety, please review these questions.

Has a doctor ever said you have heart trouble or a heart condition?
Do you frequently suffer from pains in your chest?
Do you have high blood pressure?
Do you have high cholesterol?
Do you often feel faint or have spells of severe dizziness?
Do you have a bone or joint problem that can be made worse by exercise?
Do you have Diabetes — insulin controlled or uncontrolled?
Are you taking any medications such as Beta-Blockers, diet pills, or herbal supplements?
Are you pregnant?
Do you have asthma?

IMPORTANT: If you answered “yes” to 2 or more of the above questions, you may be at risk during a rigorous exercise program. It is always recommend to have approval by your doctor to participate in a vigorous exercise program if you have 2 or more of the above conditions. By completing your registration, you agree you have answered this health history form truthfully and understand it is in your best interest to obtain a your physician’s release if you are at increased risk.

Optional Comment or Message *

Waiver and Release of Liability
THE UNDERSIGNED voluntarily wish to participate in the Outdoor Class at Renziehausen Park in McKeesport, PA. I have been advised by the fitness trainer(s) of the importance and/or need of a current physical exam and of the risk of injury when participating in an exercise program. By voluntarily participating I hereby REPRESENT and WARRANT that I am physically capable of participating in the program and that I am not aware of any physical illness or condition that could increase my risk of injury during such participation. I understand there are risks of injury associated with participation, I am aware of the risks inherent in any exercise/health program, including but not limited to
severe personal injury and death. I understand that through my participation, I am subject to possible injury, and also understand that by my participation, I accept the risk of possible injury.

THE UNDERSIGNED AGREES to indemnify and hold harmless Dana Sandmeyer, the instructor, the City of McKeesport, The City of McKeesport Mayor, Council Members, and all officers, agents and employees of such, from any and all liability for personal injuries (including death) and property damage occasioned by or in connection with any activity I perform or engage in on the City of McKeesport property. As additional consideration, I for myself, my heirs and my legal representatives, RELEASE AND FOREVER DISCHARGE Dana Sandmeyer, the instructor, City of McKeesport, The City of McKeesport Mayor, Council Members, and their successors and legal representatives, and all officers, agents and employees of each of them, of and from ANY AND ALL CLAIMS, DEMANDS, RIGHTS, AND CAUSES OF ACTION OF WHATEVER KIND AND NATURE, arising from, and by reason of any and all known and unknown, foreseen and unforeseen personal injuries (including death) and property damages that I may sustain as a result of or in any way related to any activity I engage in on the City of McKeesport property.
By signing below I declare that I have read and understand the above WAIVER AND RELEASE.

Enter /s/ followed by your name to sign that you agree to the above Waiver and Release * *

Choose One *

Drop In- One class $7.00 5 Class Pass - $25.00 ($5 per class) 10 Class Pass - $45.00 ($4.50 per class) 20 Class Pass - $80.00 ($4.00 per class)

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