Welcome to your online Wellness Schedule!
21 Day Challenge:

All PHSA Locations! Register for the 21 Day Taste of Wellness Challenge. Change your health, change your life in just 21 Days.

True Health tip of the month:

Remember to stay hydrated & drink at least 8 cups of water per day!

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Manual Class Registration
Please enter in all required fields as marked by * beside each field name.

*Name:
*Email:
*Phone Number:
*Work Number:
*Local Extension:
*Department and Work Location:
*Best time to contact you:
*Which type of class are you registering for?:
*What is the day of the class that you want to register for?:
*What time is the class you are you registering for?:
*What location is the class you are registering for?:
*Are you registering for massage? If so would you like 15, 30 or 45 mins of massage?:
*Are you registering for our weight loss coaching program?:
Yes   No
*Are you registering for our life coaching program?:
Yes   No
*Are you registering for small group personal training ? (2-3 people):
Yes   No
*Would you like more information about the different programs that we offer?:
Yes   No
Special Notes:


Please note that it is optional to provide us with your credit card information on this form. This form is secure however some people feel uncomfortable with using their credit cards online. We understand this, which is why we have provided the telephone information option.

If you do not provide us with the credit card information on this form we will contact you by telephone so that you can provide us the credit card information over the telephone.

Your registration will be complete 24 hours after we receive your credit card information.


*Credit Card Information
* Important Note: This page is secure. You have the option to complete this form or to leave it blank. If you decide to leave it blank one of our representatives will contact you by telephone for your credit card information. In either event your credit card will not be charged until we have received the required minimum number of registrants for the class.


First Name:
Last Name:
Card Type:
Card Number:
Expiration Date:
Card Verification Number:
(Last 3 Digits on Back of Card):