Thursday, March 11, 2010

Sign Up Epsom

Note: Please scroll down for Registration Form

Times:

5:00am – 6:00am: Monday, Tuesday, Thursday, Friday

6:15am – 7:15am: Monday, Tuesday, Thursday, Friday

9:00am – 10:00am: Monday, Tuesday, Thursday, Friday (Ladies Only)

4:00pm – 5:00pm: Monday, Tuesday, Thursday, Friday

6:00pm – 7:00pm:  Monday, Tuesday, Thursday, Friday March Class Full, Please Call

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You have made a great decision to come to Get Fit NH Bootcamp! We look forward to helping you achieve your maximum health and fitness!

To reserve your boot camp slot, please fill out the registration and health history form below. It is important that we have this information so we can serve you better!

After submitting your registration, we will contact you with any questions and to schedule an orientation, if necessary. You will also be forwarded to make your secure payment. If you have any challenges with this form, please let us know.

Thank-you, and we look forward to meeting you soon!


General Information
  1. Cr8 Health & Fitness is committed to protecting your privacy. We do not sell, trade or rent your personal information to others. Your confidentiality is very important to us, and information collected is used solely to allow us to serve you better.
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  18. Choose Dates & Time
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  21. Health & Medical History
  22. *Please Answer All Questions. If you have been with us before, please update any changes to your health status.
  23. Has a physician ever said you have a heart condition and should only do physical activity recommended by a physician?
  25. When you do physical activity, do you feel pain in your chest?
  27. When you were not doing physical activity, have you had chest pain in the past month?
  29. Are you 55 years of age or older?
  31. Is there a history of heart disease (prior to age 55) in your immediate family?
  34. Do you ever lose consciousness or do you lose your balance because of dizziness?
  36. Do you have high blood pressure?
  38. Is a physician currently prescribing medications for your blood pressure or heart condition?
  40. Do you have a joint or bone problem that may be made worse by a change in your physical activity?
  43. Are you pregnant, or have you been pregnant within the last 3 months?

  45. Have you had major or minor surgery in the last 3 months?
  47. Have you been hospitalized in the last 2 years?
  50. Do you have Type I or Type II diabetes?
  52. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
  55. Do you take any prescribed medications on a permanent or semi-permanent basis?
  58. Have you ever been found to be anemic (low blood count)?
  60. Do you have asthma?
  62. Have you ever injured your back or neck?
  64. Do you have back pain?
  67. Do you have any other physical conditions which cause pain (knee, hip, shoulder, etc.)?
  70. Do you receive regular physical exams from your primary care physician?
  73. Do you have any other health, medical or injury conditions that your trainer should be aware of?
  76. Do you know of any other reason you should not exercise or increase your physical activity?
Approval of Health & Medical History
  1. I certify that I understand the forgoing questions and my answers are true and complete. I also understand that if this information changes in any way in the future, it is my responsibility to notify my trainer, and that I assume the risk for any changes in my medical condition that might affect my ability to exercise.
  2. I acknowledge that it is recommended to consult a physician prior to starting any health/fitness/nutrition program, and that only a qualified health care provider is able to diagnose and prescribe treatment for specific health conditions. If I choose not to obtain a physician’s consent, I hereby agree I am doing so solely at my own risk.
  3. I agree to the above statement
Training Agreement
  1. We want everyone who participates in Boot Camp to have fun, be committed to the process, and achieve results. We want you to be so thrilled with your Boot Camp experience that you'll want to come back, and bring your friends and family with you.
  2. Please checkmark the following statements:
  3. I agree to show up for boot camp on time every day I have signed up for unless I have notified my boot camp director in advance or I have an excused absence from my doctor.
  5. I understand that I may appear in images or video relating to my participation in boot camp, and give full permission to Cr8 Health & Fitness, LLC to use these royalty-free in advertisements, promotions or commercials.
  7. I agree to confidentiality with respect to services provided by Get Fit NH Boot Camp. I further agree that I will not engage directly or indirectly in the outdoor fitness or boot camp fitness business within a 30 mile radius of any Get Fit NH Boot Camp.
  9. I understand there is no cash refund policy, but credit toward another boot camp may be applied if I am unable to continue due to circumstances beyond my control. I further understand that no credit may be applied to any other services Cr8 Health & Fitness, LLC may offer.
  11. I understand that diet and nutrition directly affects my performance and fitness results.
  13. I further agree to bring a positive attitude, use my strengths to help others attending boot camp, respect all other participants, embrace challenges, and most importantly, be prepared to have fun!
Waiver of Liability
  1. Have you completed, signed and agreed to the Waiver of Liability, Indemnity Agreement and Assumption of Risk form with Cr8 Health & Fitness/Get Fit NH Bootcamp?
  3. If no, click here to download the form.
    Please read it, sign it and bring it with you on your first day.
Digital Signature
  1. By typing your name into this field, you are hereby providing a digital signature
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  4. Upon submitting registration, you will be forwarded to another page to complete payment options. This may take 1-2 minutes. If you have challenges with this form, please let us know.
 

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