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? None 1 - 2 times a week 3 - 4 times a week 5+ times a week

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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CANCELLATION POLICY

1. GROUP TRIATHLON TRAINING CANCELLATION
Cancellation shall be made 7 days prior to session start date; a $50 processing fee shall be deducted before any refund is made. Any cancellation made after the 7 day limit shall not be refunded.

 

All cancellations shall be made by email to lori@vixentraining.com. In the event you have not received an email confirming your cancellation within 24 hrs, please call (310) 781-0135 immediately to verify confirmation.

 

2. PRIVATE SESSION CANCELLATION
Cancellation shall be made 48 hours in advance of the session date time otherwise such session shall be charged in full.

All cancellations shall be made by email to lori@vixentraining.com. In the event you have not received an email confirming your cancellation within 24 hrs, please call (310) 781-0135 immediately to verify confirmation.

 

3. BEACH WORKOUT POLICY
Monthly purchase is valid for the respective month for which it was purchased.
1 ticket purchase is valid 30 days from purchase date.
5 ticket pack purchase is valid 30 days from purchase date.
10 ticket pack purchase is valid 60 days from purchase date.
No refunds made on beach workout purchases unless cancellation caused by weather.

 

4. WEATHER POLICY
Training rain or shine unless IT IS AN ABSOLUTE DELUGE!

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