* Required Field

By selecting "I Agree" I hereby authorize the staff of Fleming Fitness Factory, LLC to act for me according to their best judgment in any emergency requiring medical attention, and hereby waive and release Fleming Fitness Factory, LLC from any and all liability.

Acknowledgment Statement

Electronic Signature

By typing your name in the Parent/Guardian Signature field, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

* Required Field