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Fill out this form to register for a FREE lesson.

Must be 18 or over to attend. Anyone under 18 must be accompanied by a parent or guardian for the first lesson in order to sign a release form. Parent or Guardian must present a valid State I.D. to register minor.

Please bring a valid State I.D. which is required for the lesson. We do not do anything barefoot so please bring an extra, clean pair of sneakers which you can change into in our lobby. This will help us keep the training floor free of dirt and glass.

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To register please fill out the entire form. All fields must be filled out to receive a FREE lesson.
First Name:
Last Name:
Date of Birth: Month, Day, Year
Email:
Home Address:
City:
Zip code
Phone where we can reach you:
Request FREE lesson in:	Cardio kick 13-17 years old Cardio kick 18 and over Boxing 13-17 yrs old Boxing Adult 18 and over MMA Fitness/MMA Pro 13-17 yrs MMA Fitness/MMA Pro Adult 18+ Boot Camp Children's Martial Arts Teen/Adult Martial Arts
How did you hear about us? Please Tell
If referred, please list their name here. One name only.
Select as many reasons for enrolling:	Confidence Weight loss Health Fun Toning Stress Relief Discipline Self Defense
What day works best for your FREE class?:
Any Cardio kick, Boxing or MMA experience?	Yes No
Parents Information if under 18 years of age.
Mom's Full Name
Mom's Cell Number
Dad's Full Name
Dad's Cell Number
Parents must come in to sign a release form the first time. We can not send it to you. Parents please bring valid I.D.

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We highly recommend you watch MAXtube videos if you are participating in a FREE lesson. It will give you an idea of our classes and you can learn the basics before taking your FREE lesson.

NOTICE:

M.A.X. Fitness urges all persons to obtain a physical examination from their physician prior to taking any Martial Arts or Fitness lesson. In recognition on the possible dangers connected with any physical activity, participant(s) hereby knowingly and voluntarily waive any right by filing this form to cause action of any kind whatsoever arising as the result of such activity from which any liability may or could occur to M.A.X. Fitness, its officers, employees or instructors. I give permission to the person listed to take class. I also give permission to M.A.X. Fitness to have myself or child taken to the hospital in case of an emergency.

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If you live in the following towns of Plainview, Melville, Dix Hills, Woodbury, Muttontown, Brookville,Syosset, Jericho, Greenlawn,Oyster Bay, Laurel Hollow, Farmingdale, East Farmingdale, South Farmingdale, West Hills, East Hills, Huntington, Huntington Station, South Huntington, Lindenhurst, Babylon, Bethpage, Old Bethpage, Carle Place, Mineola, Westbury, Garden City, Levittown, Hicksville, East Meadow, Lynbrook, Rockville Center, Valley Stream, Wyandanch, Wheatley Heights, Commack, Merrick, Wantagh, Bellemore, New Hyde Park, Salisbury, Massapequa, Massapequa Park, East Massapequa, Seaford, Amityville, Copiague, Williston Park, or Nassau County then you are close enough to come train with us!