Online Registration Form and waiver

Online Team Registration and Waiver

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

1. What are your goals for this season? Fitness, health, lifestyle, specific distance or time, etc… *

2. What are your long term goals for fitness, health and/or lifestyle? *

3. What is your fitness background? What do you currently do for exercise? *

4. How did you hear about Keep Moving Mama? If it’s a friend, include her name so we can thank her. *

5. What do you hope to gain by joining? *

6. How many servings of fruits & vegetables do you eat each day? *

7. How many ounces of water? *

8. Anything else your trainer should know? *

Click here to read waiver. Once you are done, click the BACK button on your browser to return to this form.

I have read and agree to the waiver above. *

I agree

Once you click SUBMIT you'll be taken to the Progress Report page. It will take less than 20 minutes to complete and is required to join the team. Let's go!!!

Submit

​Online Team Registration and Waiver

Online Team Registration and Waiver