Sonoran Dolphins Intake Form Name Email * Phone Number Location * 1. Do you have a fear of water? YES NO 2. Are you interested in Group or Private classes? GROUP PRIVATE BOTH 3. Do you have the ability to enter/exit the pool independently – 4 steps, 6-8” rise, handrail? YES NO Not Sure 4: What intensity level are you interested in for your workouts LOW MODERATE HIGH 5: What are your goals? – select all that apply. WEIGHT LOSSSTRENGTHMOBILITYBALANCEENDURANCEOTHER Please explain. 6: Do you have any injuries or surgeries that you’re recovering from? YES NO If yes, please explain. 7: Do you have any disabilities or limitations that should be considered when selecting the right Wellness Aquatics class for you? YES NO If yes, please explain. 8: Will you be needing a handicap parking spot and/or ramp access? handicap parking ramp access BOTH None 9: What key words did you search that lead to finding our WA Fit program?