Runner Analysis Program Time Slots

What in? Total

Select Slot

Any Tuesday (Justin Sazon)

5:00pm

Any Wednesday (Morgan Gossett)

7:00am

Any Wednesday (Christopher Graves)

5:00pm

Any Friday (Christopher Graves)

7:00am

Any Friday (Morgan Gossett)

12:00pm

Any Friday (Justin Sazon)

12:00pm

Name

Age

Date of Birth

Gender

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Describe any injuries or limitations

Are you training for an event?

What shoes do you run in?

What are your goals?

I agree and represent that all exercises and all use of West Texas Rehabilitation Center (WTRC) facilities will be undertaken at my own risk, that I am in good physical condition, and that WTRC and its agents are not liable for any injuries, damages, or actions arising from my participation.

Release of Liability

I have read and agree to the terms and conditions stated above.

Signature

Clear Signature

Todays Date

Mobile Marketing Consent

I consent to receive marketing emails from West Texas Rebab at the email address I provided.

Payment Information

Total

Item Quantity Qty Total

There are no products selected.

Any Tuesday (Justin Sazon) - 5:00pm 1 $100.00

Any Wednesday (Morgan Gossett) - 7:00am 1 $100.00

Any Wednesday (Christopher Graves) - 5:00pm 1 $100.00

Any Friday (Christopher Graves) - 7:00am 1 $100.00

Any Friday (Morgan Gossett) - 12:00pm 1 $100.00

Any Friday (Justin Sazon) - 12:00pm 1 $100.00

Total $0.00

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