I rate my current fitness level as a (1-10), ten being high. — Low 1 2 3 4 5 6 7 8 9 10 High
How did you hear about us?
This is my first camp: — Yes No
If you answered “no”, when was the last camp you attended?
My main goal is:
Name of Emergency Contact:
Emergency Contact Phone Number:
(If you are a returning camper, only complete the sections that have changed.)
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)? — Yes No
List Medications:
2. Do you take any prescribed medication on a permanent or semi-permanent basis? — Yes No
List Medications:
3. Do you have a seizure disorder (epilepsy)? — Yes No
4. Do you have diabetes Adult or Juvenile? — Yes No
List Medications:
5. Have you ever been found to be anemic (low blood count)? — Yes No
6. Do you have High Blood Pressure (hypertension)? — Yes No
List Medications:
7. Do you have or have you ever had the following diseases?
Lung Disease: — Yes No
Kidney Disease: — Yes No
Liver Disease: — Yes No
Heart Disease: — Yes No
8. Do you have asthma? — Yes No
List Medications:
9. Have you ever had a severe neck injury?
10. Have you ever been knocked out?
11. Do you wear glasses or contact lenses? — Yes No
12. Have you had a broken bone or fracture in the past 2 years?
12. Have you ever injured your back?
14. Do you have back pain? — Never Seldom Occasionally Frequently
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
16. Do you have other physical conditions which cause pain?
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested? — Yes No
If yes, what percent is it?
20. Are you training for a specific event?
NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!
THIS RELEASE IS ENTERED INTO BETWEEN THE UNDERSIGNED AND BOOTCAMP FOR WOMEN BY GABLES FITNESS, LEAN ON ME FITNESS, INC, ITS OFFICERS, SUBSIDIARIES, AFFILIATES AND EXECUTORS IN ADDITION TO THE CITY OF MIAMI, CITY OF CORAL GABLES, CITY OF CORAL GABLES PARKS AND RECREATION,CITY OF PINECREST, PINECREST PARKS AND RECREATION, MIAMI DADE PARKS AND RECREATION. BAPTIST HOSPITAL IS NOT AFFILIATED WITH BOOTCAMP FOR WOMEN BY GABLES FITNESS.
1. ACKNOWLDGES THAT BOOTCAMP FOR WOMEN INSTRUCTORS ARE NOT A PHYSICIAN AND IS NOT TRAINED IN ANY WAY TO PROVIDE MEDICAL DIAGNOSIS, MEDICAL TREATMENT, OR ANY OTHER TYPE OF MEDICAL ADVICE.
2. ACKNOWLEDGES THAT THE UNDERSIGNED HAS BEEN TOLD IF THEY FEEL TIRED, FEEL PAIN OR FEEL OUT OF THE ORDINARY IN ANYWAY EITHER RELATED TO BOOTCAMP FOR WOMEN WORKOUTS OR OTHERWISE, THAT THE UNDERSIGNED SHOULD CONTACT A PHYSICIAN AT ONCE
BOOT CAMP FOR WOMEN MEMBER/PARTICIPANT ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF BOOTCAMP FOR WOMEN BY GABLES FITNESS, OR IT’S EMPLOYEES, CONTRACTORS, OFFICERS,OR OWNER/S.. PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES. BOOTCAMP FOR WOMEN BY GABLES FITNESS MEMBER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT AR NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BOOTCAMP FOR WOMEN PARTICIPANT, SLIP AND FALL BY BOOT CAMP FOR WOMEN PARTICIPANT, OR AN UNKNOWN HEALTH PROBLEM OF BOOT CAMP FOR WOMEN PARTICIPANT. BOOT CAMP FOR WOMEN PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, BOOT CAMP FOR WOMEN PARTICIPANT AFFIRMS THAT BOOT CAMP FOR WOMEN PARTICIPANT IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES. BOOT CAMP FOR WOMEN PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND BOOT CAMP FOR WOMEN PARTICIPANT AGREES THAT IT IS THE RESPONSIBILITY OF BOOT CAMP FOR WOMEN PARTICIPANT TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN BOOT CAMP FOR WOMEN ACTIVITIES. BY FILLING OUT THE BOOTCAMP FOR WOMEN REGISTRATION, BOOT CAMP FOR WOMEN PARTICIPANT ASSERTS THAT SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. BOOT CAMP FOR WOMEN PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.
PARTICIPANT OF BOOTCAMP FOR WOMEN IS AWARE THAT THEIR BOOTCAMP FOR WOMEN SUBSCRIPTION IS EITHER 1 MONTH ONLY, OR CHARGED MONTHLY ON A SUBSCRIPTION RECURRING BASIS BASED UPON WHICH PROGRAM PARTICIPANT SELECTS AND WILL BE CONSIDERED ACTIVE AND ONGOING UNLESS NOTIFICATION OF CANCELATION IS SENT VIA EMAIL 5 BUSINESS DAYS BEFORE NEXT BILLING DATE TO GABLESFITNESS@AOL.COM . PARTICIPANT UNDERSTANDS PHOTOS OR VIDEO MAY BE TAKEN DURING THE COURSE OF MY INVOLVEMENT IN BOOT CAMP, WHICH MAY BE USED FOR PROMOTIONAL PURPOSES. BOOT CAMP FOR WOMEN PARTICIPANT UNDERSTANDS THAT SHE IS ENTITLED TO A 30 DAY UNCONDITIONAL MONEY BACK GUARANTEE. IF AT ANY TIME DURING THE FIRST 30 DAYS OF PARTICIPATION, BOOT CAMP FOR WOMEN PARTICIPANT IS NOT SATISFIED WITH THE BOOT CAMP FOR WOMEN, THEN BOOT CAMP PARTICIPANT WILL SEND NOTIFICATION VIA EMAIL TO GABLESIFITNESS@AOL.COM AND SPECIFICY REASON REQUESTING A FULL REFUND.
NOW, RAISE YOUR RIGHT HAND AND REPEAT THESE WORDS:I WILL REMEMBER TO SET UP HELLO KITTY ALARM CLOCK AND BE AT CAMP ON TIME. I WILL BRING A POSITIVE ATTITUDE AND EXPECT TO HAVE FUN.I AGREE NOT TO USE FOUL LANGUAGE DURING BOOTCAMP FOR WOMEN. I AGREE NOT TO TALK AND TALK WHILE A CAMP IS BEING CONDUCTED. ANY VIOLATION WILL RESULT IN TWENTY PUSH-UPS PER OCCURRENCE. I AGREE TO ALL TERMS AND CONDITIONS LISTED ABOVE
THIS FORM IS VALID INDEFINITELY, FOR AS LONG AS YOU PARTICIPATE IN BOOTCAMP FOR WOMEN BY GABLES FITNESS. IF THERE IS ANY CHANGE TO YOUR PHYSICAL CONDITION, IT IS YOUR RESPONSIBILITY TO NOTIFY YOUR PHYSICIAN,GABLES FITNESS AND YOUR INSTRUCTOR.
