Aerobics 2019/2020
Page 1 of 1
Aerobics 2019/2020
IF YOU ARE USING INTERNET EXPLORER, STOP! THIS FORM DOESN'T GO THROUGH WITH THAT PROGRAM. TRY USING GOOGLE CHROME OR FIREFOX.
1.
Participant Information:
*
First Name:
Last Name:
Sex (M or F):
Street Address:
Town/City:
State:
Zip:
Email Address:
Home Phone:
Cell Phone:
Work Phone:
2.
Parent/Guardian Information (if participant is 18 years old or younger)
First Name:
Last Name:
Email Address:
Street Address:
Town/City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
3.
Program for which you are registering for (check all that apply)
*
Fall Session 2019 - Tues/Thurs (Starts 9/10) - $99/Session
Winter Session 2020 - Tues/Thurs (Starts 1/7) - $99/Session
Spring Session 2020 - Tues/Thurs (Starts 3/24) - $99/Session
4.
How would you describe your current fitness level?
*
How would you describe your current fitness level?
*
Sedentary
Active
Athletic
5.
Please list any special accommodations needed for you to be successful in our program.
6.
Method of Payment:
*
Please submit this form. If paying via check/cash, please send payment and make checks payable to the Roxbury Community School (42 North Hillside Avenue, Succasunna, NJ 07876). Please write "Aerobics" in the memo line. Payment is needed prior to the start of class. Credit card payments can be made on the next screen.
Method of Payment:
*
Please submit this form. If paying via check/cash, please send payment and make checks payable to the Roxbury Community School (42 North Hillside Avenue, Succasunna, NJ 07876). Please write "Aerobics" in the memo line. Payment is needed prior to the start of class. Credit card payments can be made on the next screen.
Cash
Check/Money Order
Credit Card
7.
If paying via check, please enter check number here.
Please mail your check to the Roxbury Community School at 42 North Hillside Avenue, Succasunna, NJ 07876. Please write "Aerobics" in the memo line.
8.
DISCLAIMER/REFUNDS: A receipt may not be given when registering. You may assume your registration has been received unless notified. There are no refunds once the program begins. All cancellations must be received in writing at least seven days prior to the start of the class for a refund. After that date, there will be no refunds. There is a $35 service charge for returned checks. Participation in Community School activities is at your own risk and medical personnel will not be on site during this program. The Roxbury Township Board of Education assumes no liability. To read the full Roxbury Community School policy, please visit www.roxbury.org/RCSpolicies.
*
--Please Select--
I understand.
9.
SOCIAL MEDIA: During Community School programs, arrangements are made to take pictures, video, or live-post to social media sites. School personnel, a media student or a newspaper photographer may obtain content for use in local media, on the district website, student publications/outlets to showcase the wonderful things happening within the district. The participant's name may be included, especially in a caption of a picture containing their likeness. By completing this form, participation is implied.
*
--Please Select--
Yes
No
10.
How did you hear about this program?
*
Check all that apply.
Email
Facebook
Flyer
Newspaper
Previous Participant
Website
Weekly Roxbury School's E-Blast Newsletter
What's Happening E-Blast Newsletter
Word of Mouth
Other, please specify
11.
Would you like to be added to the Roxbury Community School email contact list announcing different programs and trips?
--None--
Yes
No