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Gym Health Waiver

To register to our gym please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities? *

No

Yes

Have you lost your consciousness in the last past 12 months? *

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

WhatsApp: +352 621 458 588

CONTACT

142, rue Albert Unden

L-2652 Luxembourg

RYTHMO-CATS CLUB DE GYMNASTIQUE RYTHMIQUE ASBL
IBAN: LU65 0027 3100 2612 4600
BIC : BILLLULL

RYTHMO-CATS CLUB DE GYMNASTIQUE RYTHMIQU
IBAN LU89 1111 7551 8641 0000
BIC : CCPLLULL

RCS Lux. F 9029

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