This form may be mailed in along with your registration form, brought to the first class,
or faxed to:
919-882-1130 for Wake County classes
or 615-712-9017 for Durham County classes.
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Pre/Postnatal Fitness Classes, Seminars and Instructor Workshops
Medical Permission Slip
_________________________________________________
has my permission
Physician/Midwife Name:_______________________________________________ Signature:_______________________________________________ Phone: _______________________________ Date: __________________________ Special Restrictions: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ |