So that we may assist you in selecting the best Wellness Aquatics class(es) for you, please complete this form. We will contact you shortly. If you don’t hear from us within one business day, please call us at 520-638-8040. WELLNESS AQUATICS NEW CLIENT 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 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 What key words did you search that lead to finding our WA Fit program?