Saturday, July 31, 2010

SuperMommies Registration


NH SuperMommies

Thank-you for choosing to train with NH SuperMommies. For you and your baby’s safety, we require a Physician Consent Form be completed and returned before you start classes.

Please download your copy here.


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.
  2. (required)
  3. (required)
  4. (valid email required)
  5. (required)
  6. (required)
  7. (required)
  8. (required)
  9. (required)
  10. (required)
  11. (required)
  12. (required)
  13. (required)
  14. (required)
  15. (required)
  16. (required)
Choose Start Date
  1. (required)
Health & Medical History
  1. *Please Answer All Questions. If you have been with us before, please update any changes to your health status.
  2. Has a physician ever said you have a heart condition and should only do physical activity recommended by a physician?
  4. When you do physical activity, do you feel pain in your chest?
  6. When you were not doing physical activity, have you had chest pain in the past month?
  8. Is there a history of heart disease (prior to age 55) in your immediate family?
  11. Do you ever lose consciousness or do you lose your balance because of dizziness?
  13. Do you have high blood pressure?
  15. Is a physician currently prescribing medications for your blood pressure or heart condition?
  17. Do you have a joint or bone problem that may be made worse by a change in your physical activity?
  20. Are you pregnant, or have you been pregnant within the last 3 months?

  22. Have you had major or minor surgery in the last 3 months?
  24. Have you been hospitalized in the last 2 years?
  27. Do you have Type I or Type II diabetes?
  29. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
  32. Do you take any prescribed medications on a permanent or semi-permanent basis?
  35. Have you ever been found to be anemic (low blood count)?
  37. Do you have asthma?
  39. Have you ever injured your back or neck?
  41. Do you have back pain?
  44. Do you have any other physical conditions which cause pain (knee, hip, shoulder, etc.)?
  47. Do you receive regular physical exams from your primary care physician?
  50. Do you have any other health, medical or injury conditions that your trainer should be aware of?
  53. 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
  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 NH SuperMommies.
  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 further agree to bring a positive attitude, use my strengths to help others attending class, respect all other participants, embrace challenges, and most importantly, be prepared to have fun!
Waiver, Release and Assumption of Risk
  1. This release is entered into between the undersigned and Cr8 Health & Fitness, LLC, its officers, employees, volunteers, subsidiaries, affiliates and executors. The purpose of Cr8 Health & Fitness, LLC is to provide fitness and exercise coaching and instruction.
  2. The undersigned hereby acknowledge that the following was explained to them and/or agrees to the following:
  3. 1. Acknowledges that it is recommended to consult a physician prior to starting any health/fitness/nutrition program. If I choose not to obtain a physician’s consent, I hereby agree I am doing so solely at my own risk.
  4. 2. Acknowledges that Dean Carlson, CPFT and/or Nancy Carlson, CPFT is/are not a physician and is not trained in any way to provide medical diagnosis, medical treatment, psychotherapy, or any other type of medical advice.
  5. 3. Acknowledges that fitness training is another tool for teaching individuals about themselves, but that Cr8 Health & Fitness, LLC does not guarantee neither good nor bad will occur nor guarantees the coaching advice and/or training given by Cr8 Health & Fitness, LLC will produce good nor bad results.
  6. 4. Acknowledges that boot camps, aerobic training, running, obstacle courses, weight training, and any other related sports, whether or not requiring the use of exercise equipment, 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 Cr8 Health & Fitness, LLC for the undersigned participating in said sporting events and/or training for said sporting/fitness activities.
  7. 5. The Undersigned agree that this is the full agreement between the parties, that Cr8 Health & Fitness, LLC 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.
  8. I have read and agree to the above terms and conditions.
Digital Signature
  1. By typing your name into this field, you are hereby providing a digital signature
  2. (required)
  3. (required)
  4. I am paying by
  6. 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.
Training Agreement
 

cforms contact form by delicious:days

blog comments powered by Disqus