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Wellness Wednesday Zumba Sign-Up
Join us for Wellness Wednesday Zumba at the Corpus Christi-Nueces County Health District (1702 Horne Rd.). Age minimum to participate is 7 years old.
Wednesday, May 20 @ 5:45-6:45pm
Name
*
First Name
Last Name
Age
*
Must be at least 18 years old to attend without a guardian.
Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Home Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Will you bring any children?
*
Please Select
Yes
No
Please provide their full name and age.
Full Name
Age
Full Name
Age
Full Name
Age
Do you or your child(ren) have any pre-existing conditions or injuries that our instructors should know about?
*
Please Select
Yes
No
Please list the pre-existing conditions or injuries.
Please read the waiver and sign below.
By signing below, I agree that my electronic signature is the legal equivalent of my manual signature on this application.
*
Submit
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