Session Registration:

Please complete the following questions to register for our April sessions beginning April 4. The live sessions will run MWF mornings at 5:45am and 7am. Recordings will be available for anyone who can’t attend live. If you have any questions, please send a message to our Cornerstone Facebook page or contact Jennie 612-790-1046.

The class video links for Zoom will be sent out via a text messaging system each day (Remind). Make sure you check your email this week for the code to get into the messaging system! We will also add you to our private Facebook group where we provide additional support, tips, encouragement, & answer questions. Thank you and we look forward to working with you!

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* 1. Who are you and how can we get a hold of you?

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* 2. How did you hear about our classes? Did someone refer you to our classes? (Please tell us who so we can thank them!)

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* 3. How old are you?

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* 4. How would you describe your fitness ability and knowledge of exercise movements overall?

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* 5. What goal(s) are you hoping to reach from participating in this class?

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* 6. Please pay for your sessions no later than Friday, April 3. Credit card payments are preferred due to the current "Stay At Home" order, but you can drop off a check or cash if needed to Cornerstone Chiropractic. It is $25 for 4 weeks of sessions, lasting from April 4 to May 2.

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* 7. IF PAYING BY CREDIT CARD: Do you authorize Cornerstone Chiropractic to make a one time charge of $25 to the credit card you provide for the fitness classes starting April 4, 2020?

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* 8. Name on Card
Expiration Date
Security Code
Card Number

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* 9. Informed Consent and Liability Waiver Release: Please type your full name in the box when you have read it.

I agree and consent to the following:

I am voluntarily participating in the online interval training sessions taught by Christa Landmark, Heather Bredeken, & Jennie Gunlogson at Cornerstone Chiropractic in Montevideo, MN. I recognize that the program requires physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the above mentioned program. I represent and warrant that I have no medical condition that would prevent my participation in the program.

I agree to assume full responsibility for any risks, injuries or damage know or unknown which I might incur as a result of participating in the program. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death.

I knowingly, voluntarily and expressly waive any claim I may have against Christa Landmark, Heather Bredeken, Jennie Gunlogson or Cornerstone Chiropractic for injury or damages that I may sustain as a result of participating in the program.

I, my heirs or representatives forever release, waive, discharge and covenant not to sue Christa Landmark, Heather Bredeken, Jennie Gunlogson or Cornerstone Chiropractic for any injury or death caused by their negligence or other acts.

I have read the above waiver and release of liability and fully understand it contents. I voluntarily agree to the terms and conditions stated above.

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