STRONG AS A MOTHER

Personalized Postpartum Fitness for Moms

Please fill out this form to register and our CORE Team will contact you soon.

First Name *

Last Name *

Child's Name

Child's Age

Email *

Phone *

Address *

City *

State *

Zip Code *

I am cleared by a physician to exercise. *

yes

I have some restrictions

Do you require any adaptations specific to injuries or other physical limitations? *

Do you have any chronic health conditions, injuries, allergies, prior surgeries, or any other health- related info that we should be aware of? *

Do you take any medications that would alter your heart rate or blood pressure? *

Yes

By checking the box below, I agree to assume full responsibility for any risks, injuries, or damages, known and unknown, which might occur as a result of participating in movement activities with Create Your Core LLC, Jennifer Penn.) I voluntarily agree to waive any claim/ suit related to personal injury or damages related to participating in classes/workshops/pop up clincs. I am cleared by a physician to exercise and statements about my need to know health condition/s are provided. I have carefully read this waiver of liability and understand that I am giving up legal rights, including my right to sue. I acknowledge that I am signing this waiver freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the extent allowed by law. *

I confirm and agree to the statement above.

SIGNATURE: *

Clear