Sean's COMPLETE WELLNESS :: Registration :.

	Sean´s Complete Wellness 519•854•5602
.: Speed :: Power :: Agility :: Balance :: Aerobic Capacity :: Core Stability :: Weight Management :.

Sean´s Complete Wellness
519•854•5602

Registration

Sean´s Complete Wellness

Program:^*			*

Applicant Information
Name:	First^*		*
	Initial
	Last^*		*
	Gender^*	Male Female	*
	Age^*		*
	Date of Birth^*	(dd\|mm\|yyyy)	*

Address:	Street
	Unit
	City
	Province
	Postal Code	—
Phone Number^*		— —	*
E-Mail^*			*
Health Card#^*			*

T-Shirt Size (if applicable)		X-Small Small Medium Large X-Large XX-Large

Permission to use your photo on our website or 'Facebook'?				Yes No

Emergency Contact Information
Name:	First^*		*
	Last^*		*
Phone-Number^*		— —	*

Comments? Questions?		Comments? Questions?

How did you hear about Sean´s Complete Wellness?




For “onsite” programs, please print and sign a copy of both the Registration Form and Waiver. Both documents must accompany each participant to the first session.

For onsite programs and events, payment must be made at (or prior to) the first clinic of each session. Payment may optionally be made online using our secure payment process (with PayPal and a credit card) We accept most major credit cards, cash and cheques (made payable to the Sean´s Complete Wellness).

For online programs (MAXIMUM ELEVATION & MAXIMUM AGILITY), payment must be made prior to receiving the program material. Payment may optionally be made online using our secure payment process (with PayPal and a credit card) We accept most major credit cards, cash and cheques (made payable to the Sean´s Complete Wellness).

Gift Certificates

^*Mandatory Information