Program Registration

Participation-Registration

Participant's First Name *

Participant's Last Name *

Date of Birth (mm/dd/yyyy) *

Parents name

(If participant is under the age of 18)

Address *

City *

State *

Zip *

Primary Phone *

Email *

Emergency Contact *

Emergency Contact Phone *

Membership Status - Participant is a *

Programs *

Payment Method *

Credit Card

Check

Member House Charge

PAC Gift Card

Disclaimer

I hereby waive and release rights/claims for damages I may have against the Premier Athletic Club and its employees, and all injuries that may be suffered in connection with participation in any of the Premier Athletic Club programs.

Signature *

(Signature of parent or legal guardian if participant is under 18 years of age)

Date (mm/dd/yyyy)

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"From the first day I joined Premier Athletic Club I was impressed with the friendly atmosphere and the people who attend the club. It was one of ..."
Denise Simon
"Premier Athletic club is amazing. The staff is knowledgeable and friendly. They are always willing to help. I absolutely love Valerio’s ..."
Sue Schwadron
"This gym is so convenient and the classes are as if they were specifically designed for my needs."
Lynda Rivera
"This is more than a “gym” Premier has provided my entire family with an opportunity to broaden/enhance their lives in countless ways."
Marilyn Dreyer

Disclaimer

SIGN UP FOR ATRIAL MEMBERSHIP

Denise Simon

Sue Schwadron

Lynda Rivera

Marilyn Dreyer

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