SoCal Fitness Boot Camp for Women

You have 2 options:
1. Register online & pay by check via mail
2. Register & pay online by credit card (secure)

If you choose option 1 (to register by mail):
FIRST fill out this form online & click SUBMIT, THEN mail your payment with your name on the check.

If you choose option 2 (to register & pay securely online):
FIRST fill out this form & click SUBMIT, THEN follow instructions to pay by credit card.

NOTE: Spaces fill quickly. We cannot guarantee your space until we've received payment.

SoCal Fitness Boot Camp for Women
2604-B El Camino Real, #249
Carlsbad, CA 92008
(760) 634-1650


Full Name
Address
City
State		ZIP

Date of Birth	(mm/dd/yyyy)
Phone Number		Cell phone
Coupon Code
Email Address

How do you rate you fitness level (1-10), ten being highest?
How did you hear about us?
Is this your first boot camp?”	Yes \| No	If you answered "no", when was the last camp you attended:
Name of Emergency Contact		Phone Number of Emergency Contact

4-Week Camp Rate: 20 Session (5x/week) Only $199; 16 Sessions (4x/week) Only $175; 12 Sessions (3x/week) Only $149 or 9 Sessions for $129. Please select camp date, time, number of sessions & location you want to attend

Time:
NOTE: Be sure that camp location you wish to attend has the time you want available.
Location:
Form of payment:
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
List Medications:
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
List Medications:
3. Do you have a seizure disorder (epilepsy)?
List Medications:
4. Do you have diabetes?
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
List Medications:
7. Do you have or have you ever had the following diseases?
Heart Disease:
Lung Disease:
Kidney Disease:
Liver Disease:
8. Do you have asthma?
List Medications:
9. Have you ever had a severe neck injury?
If yes, please describe:
10. Have you ever been knocked out?
If yes, please describe:
11. Do you wear glasses or contact lenses?
12. Have you had a broken bone or fracture in the past 2 years?
If yes, please describe:
13. Have you ever injured your back?
If yes, please describe :
14. Do you have back pain?
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
If yes, please describe:
16. Do you have other physical conditions which cause pain?
If yes, please describe:
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested?		If yes, what percent is it?
20. Are you training for a specific event?
If yes, explain:
NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program! RELEASE This release is entered into between the undersigned and SoCal Fitness Boot Camp, its officers, subsidiaries, affiliates, instructors, and executors in addition to the Cities of Carlsbad and Encinitas, and any cities where boot camps are held. The purpose of SoCal Fitness Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals. The undersigned hereby acknowledges that the following was explained to me and/or agrees to the following: 1. Acknowledges that SoCal Fitness Boot Camp and its Personal Trainers are not physicians, and are not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. 2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that SoCal Fitness Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by our Personal Trainers/Instructors including SoCal Fitness Boot Camp will produce good nor bad results. 3. Acknowledges that the undersigned has been informed if they feel tired, feel pain or feel out of the ordinary in any way either related to their training, or otherwise, that the undersigned should contact a physician at once. 4. Acknowledges that boot camps, aerobic classes, kick boxing, running, weight training, obstacle courses, and any other related sports are an extreme test of one’s mental and physical limits and carry with it potential for serious injury and death. That the undersigned assumes the risks of participating in these types of events and activities, that they are fit, and they have a medical physician they can contact regarding any medical problems that they might develop. 5. The undersigned expressly waives, releases, discharges and agrees not to sue from any liability of death, disability, personal injury, or action of any kind SoCal Fitness Boot Camp, its instructors, or any facilities, cities or counties where camps are held, for the undersigned participating in said sporting events and/or training for said sporting events. 6. The Undersigned agrees that this is the full agreement between the parties, that SoCal Fitness Boot Camp, its instructors nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion. 7. Camper/Client agrees to confidentiality with respect to SoCal Fitness Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of SoCal Fitness Boot Camp. The undersigned agrees to a non-compete within a 50-mile radius of SoCal Fitness Boot Camp for a period of 5 years from date of participation. Checkmark the following: I agree not to use foul language during Boot Camp. I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors. I understand that photos or video may be taken during the course of my involvement in Boot Camp, which may be used for promotional purposes only. I understand that no "before & after" photos will be used for any promotional purposes. I understand there is no refund policy, but I can receive a partial credit (for unused portion of camp) towards a future camp if I'm not able to complete the one I originally joined due to major injury (with a doctors note). Camp fees can not be used towards any other products or services provided by SoCal Fitness Boot Camp. I will remember to set my alarm and be at camp on time. I understand that diet and nutrition will affect my fitness goals and performance during boot camp.
I agree to all Terms and Conditions listed above Electronic Signature (enter full name) Date (MM/DD/YYYY) Don’t forget: If paying by check (via mail), click submit then mail payment (with your name on check) to provided address. If paying by credit card (online), click submit and follow instructions to make payment. By submitting this form, you are agreeing to all the above.