VMH Fitness Center Class Enrollment Form

* You can register via this form, email, or in person at the VMH Fitness Center, located at the Vernon Memorial Hospital.
* Payment must be made prior to attending classes. Please make check payable to VMH.
* Class space may be limited, so early registration is encouraged. Registration is on a first-come, first-served basis.
* VMH Fitness Center reserves the right to cancel classes, programs, and events for insufficient enrollment. Guests will be notified only if a class is cancelled.
* VMH Fitness Center membership entitles you to reduced class fees. Use one form per person.
* Each participant prior to the first class sesson must fill out an informed consent form. (available online)
* Questions? Call the Fitness Center at (608) 637-4290

 


Name:

Address:
Street:
City:
State:
Zip Code:

Phone Number:
Alternate Phone:

Who shall we call in an emergency?
Name:
Phone Number:

Membership Type: (select one)

Session start date: (such as "Mid-January" if date is not known)

Class Names and Fee's: (name in left box, fee in right box for up to four classes)
$
$
$
$

Total Fees: $

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