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Let's Get Started!

Please fill out this form to tell me a bit about yourself and your training goals.

Name

First Name

Last Name

Email Address

Cell Phone (Please include best time to reach you)

Age, type of occupation/lifestyle (ex: desk job or always on the run?)

Fitness history? What type of sports/physical activities have you practiced? What do you currently practice?

Please list any injuries (past and present) including any chronic pains or conditions and any recent surgeries:

What are your physical training goals? Please be specific in terms of anatomy:

Examples: Hamstring flexibility, core strength, speed, agility, shoulder mobility, posture improvement, pain relief, artistic performance?

For yoga: The right class can leave us feeling clearer, lighter, and refreshed. The ancient yogis credit this to yoga poses and breathwork that move blocked prana (life force) through the subtle energy bodies known as chakras. Please tell me about the chakras that interest you most:

Root (Pelvic Floor) Chakra- For Stability, Grounding, Strength & Confidence. Sacral (Sacrum) Chakra- For Pleasure, Creativity, Fluidity, Fertility, Positivity Solar Plexus (Naval) Chakra- Self-Esteem, Confidence, Energy, Productivity, Awaken Inner Power Heart Chakra- Love, Compassion, Forgiveness Throat Chakra- Communication, to find your Voice or your Truth. Third Eye Chakra- Intuition, Imagination, Trust, Inner Wisdom Crown Chakra- Awareness, Intelligence, Letting go, Spirituality

Please list desired start date & schedule

Days/time of day etc

Please list all MEDICAL CONDITIONS (including pregnancy) and all ALLERGIES that should be made known to medical personnel in the event of an emergency.

What is your favourite singer, group, song, or genre of music

How did you hear about Erika?

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Waiver

I certify to be in proper physical condition to participate in training with Erika Vipond. I will inform the trainer, Erika Vipond, of any specific physical conditions that I may have. I agree that Erika Vipond, her officers, employees and agents shall not be liable for any claim, demand or cause of action of any kind resulting from or related to the use of the facilities or participation in any sport, exercise or activity within the club/studio premises. I accept that neither the instructor nor the host facilities are liable for theft and or loss of personal effects or damages to property, resulting from taking this class. Finally, I release Erika Vipond and the host facility from all liability for injuries or physical problems.

Emergency Contact (Name, relationship and cell number)

Let's Get Started!

Thank you!

I will be in touch within 48 business hours to schedule a session.