Kangoo Jumps Boot Reservations

Name*

First Last

Email*

Phone*

What is your Rebound Boot Size?*

Do you weigh more than 190 lbs?*

Yes
No

**Boot configuration is based on weight, height and athletic ability. Boots need to be adjusted for anyone weighing 190 lbs or more for optimal performance.

If you answered yes to the above question, please tell me how much you weigh, how tall you are and your current athletic ability.

Reservation Dates*

COMPLIMENTARY First Class (list date below)
Single Class (Boot rental = $3) (list date below)

Please list the date of your class below.*

How did you hear about these classes?*

Emergency Contact

Name*

First Last

Phone*

Liability Waiver

I ("Participant"), hereby acknowledge that I have voluntarily enrolled in the personalized health and fitness programs ("Programs") offered by Becky Munger. I recognize that the Programs may involve strenuous physical activity. I hereby affirm that I am in good physical condition and do not suffer from any unknown disability or conditions which would prevent or limit my participation in the Programs. I understand the risks involved in my participation in the Programs, and agree to cease my participation in the Programs or any specific exercise I feel that such participation is too strenuous or places me at specific risk of injury. I further understand that Becky Munger reserves the right to refuse service to anyone for any reason at any time. As with any physical fitness program, I understand and acknowledge that there is risk of injury associated with my enrollment and participation in the Programs. As a condition of my participation in the Programs, I hereby release Becky Munger from any claims, demands, and causes of action arising from my voluntary participation and enrollment in the Programs. I further release Becky Munger from any liability now or in the future for any physical injuries that I may sustain or any conditions that I may obtain in connection with my participation in the Programs. These injuries and conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death. I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.*

Do you agree to allow use of photos/images, videos for marketing purposes by Becky Munger?*

Emergency Contact

Liability Waiver

Be sure to bring long socks, water and a towel!