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New Member Sign-Up Form

zumba-pana-the-zone-shelbyville-signup This Form is only to be used by individuals wanting to enroll as first time members.

If you only want to take advantage of our free trial session before becoming a new member, please click on the "Free Trial Session" link at the top of this page.

My name is:*

First
Last
I want the following payment option:*
- $35 – Unlimited monthly sessions
- $5 – Pay per session
The location where I will be attending classes:*
- Pana
- Shelbyville
My email address is:*
The best phone number to reach me at is:*
My mailing address is:*

Street Address
Address Line 2
City

State
Zip Code
Release of Liability – Hold Harmless Agreement 1.) In consideration of being allowed to participate in the personal fitness training activities and programs and use of its facilities, equipment and services, in addition to the payment of any fee or charge, I do hereby forever waive, release and discharge Grupfit, Renee Tucker and its officers, agents, employees, representatives, executors and all others acting on their behalf hereinafter referred to as Grupfit (“Grupfit”) from any and all claims or liabilities for injuries or damages to my person and/or property, including those caused by the negligent act or omission of any of any activities, programs or services of Grupfit or the use of any equipment at various sites, including home, provided by and/or recommended by Grupfit. 2. I have been informed of, understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved, I hereby agree to expressly assume and accept any and all risks of injury or death and promise to hold Grupfit harmless. 3. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in these activities or use of equipment or machinery. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs and use of exercise equipment. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of exercise equipment. I acknowledge that either I have had a physical examination and have been given my physician’s permission to participate or I have decided to participate in the exercise activities, programs and use of equipment without the approval of my physician and do hereby assume all responsibility for my participation is said activities, program and use of equipment and promise to hold Grupfit harmless. 4. I understand that Grupfit is providing and maintaining an exercise fitness program for me does not constitute an acknowledgment, representation or indication of my physiological well being or a medical opinion relating thereto and promise to hold Grupfit harmless. 5. I undersigned, do hereby consent and agree that Instructor has the right to take photographs, videotape, or digital recordings of me and to use these in any and all print, electronic, video and internet social media, now or hereafter known, and exclusively for the purpose of sales and marketing promotion. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release Instructor all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. By checking the following box and selecting submit, I hereby agree to all terms and conditions herein.*
- I agree.