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Community Pop-up Fitness Class
A fun, welcoming workout for all fitness levels

Join us for a special pop-up fitness class. This class is beginner-friendly, supportive, and designed to help you Move, Sweat, and FEEL GREAT!

Class Details:
Date: January 29th
Time: 10:45 AM
Location: Manhattan Gym
Duration: 45 minutes
What To Expect: Strength & Conditioning
Cost: Free
*Please wear comfortable workout clothes, and bring water & towel and

First name*

Last name*

Email*

Phone

Your Goals & Interests

(Optional - Helps us tailor the class)

What are your current fitness or wellness goals?

Improve Strength

Increase energy

Release weight

Improve mobility

Reduce stress

Build consistency with exercise

Unsure

What types of classes or activities are you most interested in?

Strength training

Cardio/conditioning

Yoga

Zumba

Bellydance Fitness

Run Club

Personal Training

Fitness Challenges

Anything you'd like the instructor to know before class?

Health & Safety Check

Have you been advised by a doctor that you should not participate in physical activity?*

No

Yes

Do you currently experience any of the following? (Check all that apply)

Heart condition or chest pain

Dizziness or fainting

Joint, muscle or back issues

Pregnancy or recent childbirth

High blood pressure or other medical condition

None of the above

Other

I understand that this class involves physical activity. I confirm that I am participating voluntarily and take full responsibility for my health and safety. I agree to inform the instructor of any conditions or injuries prior to class.

Emergency Contact Information

(Used only in case of an emergency during class)

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship to You

Cat LeBlanc

Owner | Hips In Motion

(281) 907-3931

New Orleans, LA

Motivating Women Through Movement

©2021 by Catherine LeBlanc. Designed by BMB.

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