In Nature Fitness Register Here Personal Information Name Email Phone Number Address City Zip Profession Date of Birth Self Assessment & Additional Information I rate my current fitness level as: (1-10) 1 - Low2345 - Medium678910 - High Is this your first adventure boot camp? YesNo My main goal is: I was referred by: How did you hear about us? Name of Emergency Contact Emergency Phone Number Medical History Enter N/A for any section which is not applicable to you. Are you allergic to any medication? List medications: Do you take any prescribed medication? List medications: Do you suffer from epilepsy? List medications: Are you anemic? List medications: Do you have Diabetes? List medications: Do you have High Blood Pressure? List medications: Do you wear glasses or contact lenses? NoYes Do you have Asthma? NoYes Do you have Heart Disease? List medications: Do you have Lung Disease? List medications: Do you have Kidney Disease? List medications: Do you have Liver Disease? List medications: Have you ever had a severe neck injury? Describe: Have you ever been knocked out? Describe: Have you had a broken bone or fracture in the past 2 years? Describe: Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe: Have you ever injured your back? Describe: Describe any current pain you may be experiencing: Do you have other physical conditions which cause pain? Describe: Have you had any surgical procedures? Describe: What are your goals for the next three months? Describe: Have you had your body fat tested? Describe testing and results: Are you training for a specific event? If yes, explain: Release This release is entered into between the undersigned and BABC/In Nature Fitness its officers, subsidiaries, affiliates, and executors in addition to the County of Bucks County Pa and Hunterdon County NJ. The purpose of Bucks Adventure Boot Camp/In Nature Fitness 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: Acknowledges that the trainers are not physicians, nor trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. Acknowledges that coaching/training is another tool for assisting athletes/individuals seeking to reach health/fitness goals, but that BABC/In Nature Fitness does not guarantee results. Acknowledges that the undersigned has been instructed that if they feel tired, feel pain, or feel unwell, in any way, to cease participating in class and seek medical attention from a physician. Acknowledges that live online training, boot camps, aerobic classes, martial arts, kick boxing, running, weight training, obstacle courses, and any other related training activities can be an extreme test of one's mental and physical limits and carry with it potential for damage or loss of property, serious injury, and death. The undersigned assumes the risks of participating in these types of trainings/events/activities including the elements of a natural environment. The undersigned is fit and has a regular medical physician that they can contact regarding any medical problems that might develop. The undersigned expressly waives, releases, discharges, and agrees not to sue for any liability of death, disability, personal injury, or action of any kind towards BABC LLC/In Nature Fitness/Megan Sullivan for the undersigned participating in said classes and/or training, via live online virtual training or in person. The Undersigned agrees that this is the full agreement between the parties, that BABC/In Nature Fitness, its trainers, have not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement freely and voluntarily without force or coercion. Customer client agrees to confidentiality with respect to BABC/In Nature Fitness and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of BABC/In Nature Fitness. One-on-one and small group clients must provide 24 hours' notice for cancellation to avoid forfeiting the session. Packages must be used within a specified time frame, e.g., 10 sessions twice per week must be used in 5 weeks unless otherwise agreed upon. I agree not to use foul language or whine; any violations will result in 10 Burpees per occurrence! I agree not to say the words Twinkie, Donuts, Ho-Ho's, Ding Dongs, or Cupcakes; any violation will result in twenty Burpees per occurrence! I agree to show up for every class unless it is an excused absence from my doctor or pre-approved with Megan. Any violation will result in twenty push-ups, 10 Burpees, and 20 Laps per occurrence! I understand that photos or videos may be taken during the course of my involvement in this program, which may be used for promotional/inspirational purposes and I give my consent for the same. Testimonials/media become the property of BABC LLC/In Nature Fitness to be used at their discretion. I understand there is a No Refund policy, though a credit may be issued for unused portions of the program towards a future session at the discretion of the trainer. Program fees cannot be used towards any other products or services provided by BABC/In Nature Fitness. I agree to be on time, prepared, and ready to go by the time class begins. I understand that my daily nutrition affects my health/fitness goals and attaining those goals. I will disclose on the registration form and discuss with Megan any illness, injury, physical limitations/restrictions prior to participating. I will bring a positive attitude! I agree to all Terms and Conditions YesNo Signature Signature Print Name [captcha* notarobotsize:s] [captchanotarobot] [submit "Submit Pre-Camp Evaluation"
