Please enable JavaScript in your browser to complete this form.Name *FirstLastID Number *Email *Mobile Number *Emergency Contract *FirstLastMobile Number *Please let us know which disciplines you are interested in: *Aerial HoopAerial Hammock/ StretchAerial PilatesPole FitnessFloor StretchContract Period *3 Months6 MonthsPlease select either the 3 month or 6 month option 3 Month Class and Price OptionsNone1 Class per week: R635.00 per month2 Classes per week: R1245.00 per month3 Classes per week: R1,800.00 per month4 Classes per week: R2,435.00 per month6 Month Class and Price OptionsNone1 Class per week: R600.00 per month2 Classes per week: R1010.00 per month3 Classes per week: R1,575.00 per month4 Classes per week: R1,960.00 per monthWhat is the start date of your contract? *ID Number of signee *In the event that the client to whom this form relates is a minor, this form must be completed and signed by a parent or legal guardian.In the event that the client is a minor, please tick below.I hereby confirm that I am completing this form on behalf of a minor in my legal careSubmit