If you are a returning client, go directly to payment page.


REGISTRATION FORM

Choose Program:

 

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Personal Information
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Name:

E-Mail:

Phone:

Street:

City:

State:

Zip:

Date of Birth:

Emergency Contact Name:

Emergency Contact Phone:

How often do you participate in a physical activity?

 

If yes, what kind of activity?

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Medical History
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Has you doctor ever said you have a heart condition and you should only perform physical activity recommended by a doctor?  Yes / No

Do you have epilepsy? Yes / No

Do you have diabetes? Yes / No

Do you have asthma? Yes / No

Do you have high blood pressure? Yes / No

Have you ever been found to be anemic? Yes / No

Do you lose your balance because of dizziness or do you ever lose consciousness? Yes / No

Do you take prescription medication? Yes / No

if yes, please explain:

Are you allergic to any medication? Yes / No

if yes, please explain:

Have you ever had a broken bone or fracture in the past 2 years? Yes / No

if yes, please explain:

Have you ever had any surgeries? Yes / No

if yes, please explain:

Do you wear glasses or contacts? Yes / No

How did you hear about viXen?

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Waiver of Liability
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Refund Policy

  • Group Triathlon Training
    Cancellation must be made 7 days prior to session start date. A $25 processing fee shall be applied. Any cancellation made after the 7 day limit shall not be refunded.
  • Cancellation Policy for Private and / or Small Group Sessions
    Cancellation must be made 48 hours in advance of the session time in order to reschedule otherwise session will be charged in full.
  • Rain or Shine Policy
    Training will continue unless IT IS AN ABSOLUTE DELUGE! viXen will notify you in the event of cancellation
All cancellations must be made by email to info@vixentraining.com. In the event you have not received confirmation within 24 hrs, kindly call (310) 781-0135.

I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE WAIVER: YES