To officially join our CrossFit family, we will need you to provide us with the following information. If you'd feel more comfortable doing it in person, no problem - we can take care of you at the office. 

Name *
Name
Date
Date
Address
Address
Phone
Phone
Physician's #
Physician's #
Emergency Contact #
Emergency Contact #
I have enrolled in a program of strenuous physical activity including but not limited to weight training and use of various aerobic conditioning activities. I hereby affirm that I am in good physical condition and do not suffer from any condition or disability that would create risk of injury to me or prevent or limit my participation in this exercise program. *
I hereby authorize CrossFit Helena to automatically process my monthly membership dues by way of debit entry to the specified bank account below, until notification to the contrary is given. I understand that the automatic debit will be processed on the due date of my choosing for the full amount due at the time of processing. I also understand that I will receive a 5% discount on membership dues by enrolling in autopay. *
Name On Account
Name On Account
Billing Address
Billing Address
NOTE: You may choose to bring in a voided check, select the type of account, select a due date, and sign. Thank you for signing up with our box! If you would like to receive monthly receipts, please let us know.