Register for Athlete's Arena REGISTRATION FORM Preferred Location*IrmoDowntownAre you a Parent/Guardian or the Athlete Registering?*Parent/GuardianAthleteParent/Guardian SectionThe section below must be completed by the Parent/Guardian of the Athlete, if under the age of 18.Parent/Guardian Name* First Last Parent/Guardian Phone*Parent/Guardian Email* Enter Email Confirm Email Athlete SectionThe section below must be completed for the Athlete registering for Athlete's Arena services.Name* First Last Gender*MaleFemaleDate of Birth* MM DD YYYY Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email PhoneHow did you hear about us?drive by facilityeventreferredonline searchTrainer you will be working with?Shane MillerJason BrunsonAdriane WilsonHeather KobusChristian KlootRachel ThibodeauxInterestPersonal TrainingKettlebell TrainingCrossFitSports Performance TrainingOlympic LiftingActivities you participate in:footballbaseball / fastpitchbasketballsoccertennisvolleyballwrestlingtrack and fieldstrength trainingyoga / pilatescardiovascular trainingPlease list any medical issues or previous injuries that may inhibit your training. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*yesnoDo you have pain in your chest when you do physical activity?*yesnoDo you lose your balance because of dizziness or do you ever lose consciousness?*yesnoDo you have a bone or joint problem that could be made worse by a change in your physical activity?*yesnoIs your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*yesnoDo you know of any other reason why you should not do physical activity?*yesnoWaiverIn checking the box below I agree that Athlete’s Arena is in no way responsible for the safekeeping of my personal belongings while I attend class. I understand that classes at Athlete’s Arena may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Athlete’s Arena or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. Any training involving a scheduled appointment time must be cancelled 24 hours in advance to avoid charges. In consideration for the publicity and status, Releasor hereby consents to being the subject of photographs of Releasee, together with any subject matter owned by Releasee, and hereby authorize Releasee to cause the same to be exhibited by Athlete’s Arena, with or without advertising sponsorship as still photographs, transparencies, motion pictures, television, video, or other similar media. Releasor hereby releases, Releasee, and any associates, as well as any assignees, from an and all claims for damage for libel, slander, invasion of privacy, or any other claim based on use of the above described material(s). In witness whereof, Releasor has executed this release at Athlete’s Arena, 1019 Broad Stone Road, Irmo South Carolina 29063 in the County of Richland, on the day and year this form is submitted.I agree to the terms of the Waiver as stated above.* Agree NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.