Commit to Fit Program Registration

Registration

Thank you for expressing interest in one of our programs! Please complete the form below to be added to our waitlist. Once our next classes are scheduled you will be contacted. Thank you!

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* 1. Contact Information

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address *

Phone Number *

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* 2. What program are you interested in? You may choose more than one.

The Learning Kitchen Nutrition Education(Age Range 18+)

Fork and the Road Nutrition (Age Range 60+)

Walk with Ease (In-Person Group Classes)

Rec-Connect™ (Physical Activity Demonstrations)

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* 3. Participation in the Greater Flint Health Coalition's Nutrition Education Programs will involve the use of cooking equipment and kitchen tools. It is understood and expressly agreed to by all participants, to release, indemnify and hold harmless the Greater Flint Health Coalition and Commit to Fit from any and all liability of any kind for any damage and/or injury incurred in connection with the participation in the class. It is also understood that by participation, you accept the risks inherent in the preparation, cooking and eating of food that has been prepared during class.

I have read and understand the above.

Signature