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TERRI FOX FITNESS

TERRI FOX FITNESS. 13448 w 127 th st. Overland Park, KS 66212. TerriFoxFitness@yahoo.com. (816) 204 -1339 . Client Intake Form. Name ___________________________. Getting to Know You: Ideal Class Days/Times: __________________________________ __________________________________

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TERRI FOX FITNESS

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  1. TERRI FOX FITNESS 13448 w 127thst. Overland Park, KS 66212 TerriFoxFitness@yahoo.com (816) 204-1339 Client Intake Form Name ___________________________ Getting to Know You: Ideal Class Days/Times: __________________________________ __________________________________ __________________________________ What classes interest you? __________________________________ __________________________________ __________________________________ What really brought you here? Stop and think. Don’t answer until you are able to sit quietly and reflect. __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ Basic Info: Address ________________________ ________________________ Phone ________________________ Email ________________________ Birthday ________________________ Status O Single O Long Relationship O Married Spouse ________________ Anniversary ___________ Company ________________________ Job Title________________________ Starting Line: Measurements Height _______ Weight _______ Neck _______ Chest _______ Waist _______ Hips _______ Thigh _______ Arm _______ Fitness Test Pushups _____ Squats _____ Plank _____ Lunges _____ Crunches _____ Burpees _____ StepUp-R _____ StepUp-L _____
  2. TERRI FOX FITNESS 13448 w 127thst. Overland Park, KS 66212 TerriFoxFitness@yahoo.com (816) 204-1339 Payment Info Name ___________________________ All information shared will be kept secret and secure, only to be seen by staff of Fox Fitness for organizing payments of your sessions Credit Card: Number ________________________ CVV _________ Exp __________ Banking Info: Bank ____________________________ Name _______________________ Address ________________________ Acct. # _____________________ _________________________ Routing # __________________ Would you prefer: O Automatic Withdrawal O Monthly Bill OR, attach a voided check here
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