Group Fitness Registration

Please be advised that all information is required; you will not be able to submit the form unless you fill it out completely.

Last Name: First Name:

D.O.B: (MM/DD/YEAR) / / Age:

Your Email: NU ID#:
(your NU ID# is found on the front page of myneu.neu portal)

Phone #:

Local Address: City:

State: Zip:

Click here if Local Address is also Permanent Address

Permanent Address: City:

State: Zip:

Emergency Phone # : Contact Name:

Please select your appropriate NU Status:
If other, please specify:

IMPORTANT:

* ALL FULL-TIME STUDENTS 35 YEARS OF AGE AND OLDER ARE REQUIRED TO SUBMIT YEARLY PHYSICIAN APPROVAL FORMS PRIOR TO PARTICIPATING IN THE GROUP FITNESS PROGRAM. NO EXCEPTIONS GRANTED!

* ALL OTHER MARINO CENTER PARTICIPANTS (ALUMNI, FACULTY/STAFF, PART TIME STUDENTS, & OTHERS WHO HAVE PURCHASED A CAMPUS RECREATION MEMBERSHIP ARE REQUIRED TO SUBMIT YEARLY PHYSICIAN APPROVAL FORMS REGARDLESS OF AGE. NO EXCEPTIONS GRANTED!

* NO REFUNDS WILL BE GRANTED! LATE ADMITTANCE TO CLASSES WILL NOT BE ALLOWED!

I hereby release and discharge Northeastern University, it's corporators, trustees, employees, students, and agents from any and all costs, liability, and expense for personal injury or death I may suffer in any way related to my participation in the Group Fitness Program. I also accept complete responsibility for requesting aerobic exercise and any assistance I may receive. I also understand that aerobic exercise carries with it the possibility for certain changes during or immediately after exercise. The changes may include abnormal blood pressure, fainting, disorders of heartbeat, and in very rare instances, heart attack or sudden death.

I hereby acknowledge and accept these risks. (your initials will act as your electronic signature)