Name: _______________________________________

Street: _______________________________________

City: __________________________  State: _________  Zip Code: _________

Date of Birth: __________________________________

Home Phone: (         ) ______-_________

Work Phone: (         ) ______-_________

Fax #: (         ) ______-_________

Profession: ____________________________________

E-Mail: _______________________________________

Emergency Contact Name: ________________________

Please fill in your camp :

   Dates:                          5:30AM            9:15 AM

_______________      ______          ______

Payment method (check one):
Please make checks payable to Temecula Adventure Boot Camp for Women, Inc.
Camp cost:      $299 (5 days/week)  or  $180 (3 days/week)                      

Check   ______

Money Order   ______

Temecula Adventure Boot Camp for Women Agreement

1. I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or approved with Boot Camp directors

2. I understand there is no refund policy, but I can receive a credit (for the unused portion of the camp) towards a future camp if I’m not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services.

3. 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. I understand that my “before and after” photos will not be used for any promotional purposes without my express written consent.

4. I understand that diet and nutrition will effect my fitness goals and performance during boot camp.

5. I will remember to set my alarm and be at camp ON-TIME!

_______________________
Signature

________________________
Printed Name

________________________
Date

RELEASE FORM

This release is entered into between the Undersigned and Temecula Adventure Boot Camp for Women, Inc., its officers, affiliates and executors in addition to the City of Temecula, and the county of Riverside.

The purpose of Temecula Adventure Boot Camp for Women, Inc. 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 agree to the following:

1. Acknowledges that Amy Bradley, is not a physician and is not trained in any way to provide medical diagnosis or any other type of medical advice.

2. Acknowledges that Temecula Adventure Boot Camp for Women, Inc. instructors, support staff, and affiliates are not physicians and are not trained in any way to provide medical diagnosis or any other type of medical advice.

3. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Temecula Adventure Boot Camp for Women, Inc. does not guarantee neither good nor bad will occur, nor guarantees the training advice given by Temecula Adventure Boot Camp for Women, Inc will produce good nor bad results.

4. Acknowledges that the undersigned has been told if they feel tired, feel pain, or feel out of the ordinary in any way, either related to your training or otherwise, that the undersigned should contact a physician at once.

5.. Acknowledges that boot camps, aerobic classes, martial arts, kick-boxing, kung-fu, running, weight training, obstacle courses, and any other related sports/activities are 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. That the undersigned assumes the risks for participating in these types of events/activities, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge, and agree not to sue from any liability of death, disability, personal injury, or action of any kind Temecula Adventure Boot Camp for Women, Inc., Amy Bradley for the undersigned participating in said activities or events and/or training for said activities or events.

The Undersigned agrees that this is the full agreement between the parties, that Amy Bradley 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.

____________________________                   _________________
Signature                                                             Date
____________________________
Printed Name

Medical History

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc)?
    Yes___     No___           If Yes, please list: ____________________________________
2. Do you take any prescribed medication on a permanent or regular basis?
    Yes___     No___           If Yes, please list: ____________________________________
3. Do you have a seizure disorder (epilepsy)?     Yes___     No___
4. Do you have diabetes (adult or juvenile)?     Yes___     No___
5. Have you ever been found to be anemic (low blood count)?     Yes___     No___
6. Do you have High Blood Pressure (hypertension)?     Yes___     No___
7. Do you have or have you ever had the following diseases?
    Heart Disease: Yes___     No___  ------   Lung Disease: Yes___     No___
    Kidney Disease: Yes___     No___ -----  Liver Disease: Yes___     No___
8. Do you have asthma?     Yes___     No___
9. Have you ever had a severe neck injury?     Yes___     No___
10. Have you ever been knocked unconscious?     Yes___     No___
11. Do you wear glasses or contact lenses?     Yes___     No___
12. Have you had a broken bone or fracture in the past 2 years?
      Yes___     No___        If Yes, please describe: _________________________________
13. Have you ever injured your back?
      Yes___     No___        If Yes, please describe: _________________________________
14. Do you currently have back pain?
      Never ____    Seldom ____    Occasionally ____     Frequently (with vigorous exercise or lifting) ____
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
      Yes___     No___     If Yes, please describe: ___________________________________
16. Do you have any other physical conditions which cause pain?
      Yes___     No___     If Yes, please describe: ___________________________________
17. Please describe any surgeries you’ve had: _____________________________________________
18. On a scale of 1 to 10, rate your current fitness level (10 being the highest fitness level): _______
19. Are you training for a specific event:
      Yes___     No___     If Yes, please describe: ___________________________________________

PLEASE NOTE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!

____________________________                   _________________
Signature                                                             Date
____________________________
Printed Name

Medical Clearance and Physician's Consent Form

To: Amy Bradley, 26320 Arboretum Way #301, Murrieta, CA 92563

Dear Personal Trainer:

My patient, ______________________, has advised me that he or she intends to participate in a fitness program. This program will include, but not be limited to, resistance training and cardiovascular training. The sessions will last one hour and will consist of a variety of challenging activities (running, lunges, squats, jumping, push-ups, sit-ups, upper body weight training, etc.).

Please be advised that my patient, ________________, should be subject to the following restrictions in the fitness assessment and/or in his or her exercise program:

In addition, under no circumstances should he or she do the following:

I have discussed the foregoing restrictions and limitations with my patient and, with these specific restrictions, he or she has my permission to participate in a fitness assessment and pursue an exercise program under your guidance.

Truly yours,

________________________ Date: _________________________
(Sign name here)

________________________ Phone number: _________________
(Print name here)