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Adventure Boot Camp Registration

St. Augustine Adventure Boot Camp
REGISTRATION AND PAYMENT

There are 2 steps to begin your ADVENTURE!
1. Registration: Complete the Registration Information, then click "Submit to get fit"
2. Payment: Return to the Registration page to pay by Credit Card, or mail your check.

New and Returning Campers: Your payment must be made BEFORE the first day of camp. We wish to provide the ultimate workout experience for everyone. This means all payments and paperwork must be complete before coming to camp the first day. The only exception to this will be late registration, in which case you must contact us before your first day. If you have questions about payment, please contact us prior to starting camp.

$99 (Women's MINI)	$199 (3days/week)


Name
Address
City
State
ZIP
Profession
Country
Date of Birth	(mm/dd/yyyy)
Phone Number		Work Number
Fax Number
Email Address
I rate my current fitness level as a (1-10), ten being high.
I was referred by:
How did you hear about us?:		Please specify publication / website / friend or other referral:
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 & Phone Number
Camp # and Morning or Evening:		Choose a Shirt Size:

Form of payment:
If paying by check, please make payable to: St. Augustine Adventure Boot Camp and bring to camp with you. MEDICAL HISTORY (If you are a returning camper, only complete the sections that have changed.)
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
3. Do you have a seizure disorder (epilepsy)?
4. Do you have diabetes Adult or Juvenile?		List Medications:
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? Describe:
10. Have you ever been knocked out? Describe:
11. Do you wear glasses or contact lenses? Yes No
12. Have you had a broken bone or fracture in the past 2 years? Describe:
13. Have you ever injured your back? 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? Describe:
16. Do you have other physical conditions which cause pain? 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 St. Augustine Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the City of St. Augustine. The purpose of St. Augustine Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals. The undersigned hereby acknowledge that the following was explained to me and/or agree to the following: 1. Acknowledges that Josh Romaine is 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 coaching/training is another tool for teaching athletes/individuals about themselves, but that St. Augustine Boot Camp including St. Augustine Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by St. Augustine Boot Camp including St. Augustine Adventure Boot Camp will produce good nor bad results. 3. 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. 4. Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, kung-fu, 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 damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of events/activities including the elements of a natural environment, 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 St. Augustine Adventure Boot Camp for the undersigned participating in said sporting events and/or training for said sporting events. The Undersigned agrees that this is the full agreement between the parties, that St. Augustine Boot Camp including St. Augustine Adventure Boot Camp 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. Checkmark the following: I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence. I agree not eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp. Any violation will result in twenty push-ups per occurrence. 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. Any violation will result in twenty push-ups per occurrence. 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 there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if I'm not able to complete the one I originally joined. Camp fees can not be used towards any other products or services provided by St. Augustine Boot Camp including St. Augustine Adventure Boot Camp. I will remember to set my alarm and be at camp on time. I understand that diet and nutrition will effect my fitness goals and performance during boot camp. I will bring a positive attitude, and expect to have fun! Your signature will be required at the time of your evaluation and you agree to the terms now! ____________________ Signature ____________________ Printed Name ____________________ Date
I agree to all Terms and Conditions listed above
* You must return to this page after clicking above to pay via PayPal or Credit Card.

** After submitting your registration and payment, you will be contacted via email with your Welcome information. Please add our email address to your "friends" list so your Welcome email arrives to you! Thank you! GetFit@StAugustineBootCamp.com

For More Information, Contact us at (904) 687-9476 or e-mail getfit@staugustinebootcamp.com