Other (please explain):
Please list any prescription medications you are now taking.
Please list any over-the-counter medications you are now taking.
Please list any dietary supplements you are now taking.
Health and Fitness Goals
Please check specific health and fitness goals that you want to achieve.
Additional Goals (please explain):
I do hereby state that I have, to the best of my knowledge and belief, given a correct and accurate history report.
Healthy and Fit Boot Camp Terms and Conditions
I agree to participate in a health and fitness program given by Healthy and Fit Boot Camp. During your exercise program, every effort will be made to assure your safety. However, as with any exercise program, there are risks, including increased heart stress and the chance of musculosketetal injuries. In volunteering for this program, you agree to assume responsibility for these risks and any possibility for personal damage. You also agree that, to your knowledge, you have no limiting physical conditions or disability that would preclude an exercise program.
I understand and agree that if I have any medical condition that it is my responsibility to check with my physician for any contraindications with any foods, phytochemicals, supplements, nutrients, or exercise in this program. By agreeing to these terms, you accept full responsibility for your own health and well being and you acknowledge an understanding that no responsibility is assumed by the leaders of the program.
I understand and agree the health and fitness program from Complete Health Network is not intended to treat illness, disease, or any medical condition. This program is designed to promote a healthy lifestyle and does not guarantee an illness-free life. Many complex and uncalculated conditions affect the overall well being of an individual.
I agree to waive, release, remise and discharge Healthy and Fit Boot Camp, Complete Health Network, Inc., officers, agents, representatives, and employees of any and all claims, demands, actions or damages resulting from my participation in Healthy and Fit Boot Camp.
By registering for the boot camp you are agreeing to the above terms and conditions.
In case of emergency, whom may we contact?
Phone Number (Emergency Contact)
How did you find out about our program?
Are you presently involved in a regular exercise program?
If yes, please list activity, duration and frequency (ex: power walk for 30 minutes, 4 times per week)
How active do you consider yourself? (Please choose one)
Please describe your knowledge of exercise and fitness? (Please choose one)
Check any conditions you currently have or have had in the past five years.
Register by Mail