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Ladies of White House Ride – Fun, Fitness & Friendship on the Bike!

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Health declaration

Please fill out the following form.

First name

Last name

Email*

Date of birth

Month

Day

Year

Assumption of Risk I understand that indoor cycling and fitness activities involve physical exertion that may result in injury, illness, or other health complications. I voluntarily assume all risks associated with participation.

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes illness or injury, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

Owner: Melissa McGregor

Address:1015 Stearman Drive

White House, TN 37188

Tel: 615-337-5230

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