Xtreme Hip Hop Step Beginners Class with Coach Ted Thursdays | 6PM Follow Montclair, NJ Ted@lifechangingfitnessnj.com Step Class Registration Step Class Registration Step 1 of 12 8% HiddenNext Steps: Install a Payment Add-OnTo accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.What is your weight loss goal? Lose 1-20 lbs for good Lose 21-50 lbs for good Lose over 50 lbs for good Maintain weight and get fit Increase cardio stamina I haven’t decided yet What is your age? 20s 30s 40s 50s 60s 70s+ What is your height?Feet Inches What’s your current weight? How would you describe your lifestyle? Very active Active Moderately active Sedentary Very Sedentary How would you describe your current level of exercise? 0-1 hours per week 1-2 hours per week 2-3 hours per week 3-4 hours per week 5+ hours per week Do you have any health conditions? Which of the below best describes your current priorities? I am focused on losing weight I'd like to gain some muscle I'd like to increase my cardio What is your main reason for wanting to lose weight? (Please choose what is most important) Improve physical appearance Become Healthier Engage more with family and friends Feel better day-to-day Other Other reason for losing weight: Which best describes you? My diet and activity need a lot of work I have some healthy habits I mostly eat well and stay active I am eat very clean and am very active Contact DetailsName(Required) First Last Email(Required) Enter Email Confirm Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Personal DetailsGender(Required)MaleFemaleNon-binaryAgenderMy gender isn't listedPrefer Not to AnswerHow did you hear about the 90-Day Online Coaching?Social MediaGoogleWord of MouthRefer a FriendPast ParticipantOtherDid anyone that is taking this class refer you? What are your 3 favorite songs?Song 1 Song 2 Song 3 Required AgreementsAssumption of Liability and Risk Agreement Cancellation PolicyAssumption of Liability & Risk(Required) I have read and agree to the Assumption of Liability & RiskBy checking here I acknowledge that participating in personal training could be a dangerous activity with the potential for death and serious injury. I realize that the inherent risks of participating in the training program include injuries due to equipment failures, bad decision making, and my sub-par physical and mental condition. I agree to pay attention to the condition of all equipment. I agree to abide by all rules, and if the trainer makes a specific request or instruction to me, I agree to comply. I certify that I am physically capable of participation in personal training activities and have informed the trainer of any medical or health conditions I have. I agree to supply a doctor’s note (Medical Clearance Form) should I have experienced any of the following conditions: • chest pain while exercising, • chest pain while not exercising, • loss of balance because of dizziness, • loss of consciousness, • bone or joint problems that could worsen as a result of physical activity, • prescribed medication for blood pressure or heart conditions, • doctor’s indication of a heart condition, • or any other reasons why I should not partake in physical activity. In addition, I agree to inform the trainer of any changes in my medical or health condition, while a participant in the program. I fully understand that I agree to assume all risk of potential injury, including paralysis, death, or other permanent disability, and medical expenses. I HAVE CAREFULLY READ THIS AGREEMENT. I FULLY UNDERSTAND ITS CONTENTS AND AGREE TO IT OF MY OWN FREE WILL.Cancellation Policy I have read and agree to the Cancellation Policy8 Hour Cancellation Policy: LCF enforces a strict 8-hour cancellation policy. If you have reserved your place in a session/class and fail to cancel 8 hours in advance you will be charged $15 for the session/class. Late Show Cancel Policy: LCF enforces a strict Late Cancel Policy. If you are more than 10 minutes late for your class you will forfeit your spot and incur the Late Cancel Charge of $15. You must be on time to class to properly stretch and warm-up prior to engaging in an LCF Training class. Dress Code Policy: LCF Training wants you to come to class fully prepared for strenuous activity: enclosed running shoes, athletic shorts/pants, athletic t-shirt, and water bottle. Please make sure that when the weather is cold, you wear layers of lite clothing. We reserve the right to refuse you entrance into the studio if you are not properly attired. CANCELLATION and FREEZE You have the option to cancel your Membership without penalty within seven (7) days from the execution of this agreement, due to serious illness or injury with written documentation from a healthcare professional, or due to a move more than 50 miles from an LCF Training facility (documentation may be required). From there a refund will be issued. This option can be used to allow another person to register in that availability. For more information, please contact LCF Training at (973) 498-8205 . Membership contracts may be frozen for up to (3) weeks with advance notice. Written notice for membership freeze requests must be sent to Ted@lifechangingfitnessnj.com. I HAVE CAREFULLY READ THIS AGREEMENT. I FULLY UNDERSTAND ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL. Consent I agree to the privacy policy.CAPTCHA Δ Hip Hop Step – 3-Sessions Pack $50.00 Hip Hop Step – Single Session / Drop-In $20.00 Hip Hop Step – Private 1-on-1 – 3-Pack Session $90.00 Hip Hop Step – Private Session $40.00
