FITness FUNatics Boot Camp in Chandler, AZ. Get FIT! Have FUN!

YOUR INFORMATION - * fields are required
First Name:*		Date of Birth:*
Last Name:*		Home Phone:*
Email Address:*		Cell Phone:*
Address:*		Work Phone:
City:*		Emergency Contact Name:*
State:*		Emergency Contact Phone:*
Zip Code:*		Your Job Description:
Select the desired # of classes in the drop down box:*
Session Date(s):* (select any that apply) Please Refer to the Fit-Fun Calendar for exact session dates:	July – 2011 Sept – 2011 Oct – 2011
Comments/Notes:
How did you hear about Fitness Funatics?*
My current fitness level is:*
What is your main goal for this boot camp?
MEDICAL HISTORY - * fields are required Fitness Funatics Boot Camp advises you check with your doctor before beginning any exercise or nutrition program.
Are you allergic to any medications? If yes, please specify:*
Do you take any prescribed medication on a permanent or semi-permanent basis? If yes, please specify:*
Do you have a seizure disorder?*
Do you have diabetes? If yes, please list medications:*
Have you ever been found to be anemic?*
Do you have asthma? If yes, list medication used during exercise:*
Do you have or have you ever had any form of heart, lung, liver or kidney disease? If yes, please specify:*
Do you have or have you ever had any form of cancer? If yes, please specify:*
Do you have High Blood Pressure (hypertension)? If yes, list medications:*
Have you ever had a severe neck injury? If yes, please describe:*
Do you wear glasses or contact lenses?*
Have you had a broken bone or fracture in the past 2 years? If yes, describe:*
Have you ever injured your back? If yes, describe:*
Do you have chronic joint, knee or back pain? If yes, please describe:*
Have you had knee pain in the past two years that has disabled you for longer than a week?*
Do you have other physical conditions that cause pain? If yes, describe:*

RELEASE AND WAIVER OF LIABILITY; ASSUMPTION OF RISK

This WAIVER AND RELEASE is entered into between the undersigned and Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp for and in consideration of participating, voluntarily, in a outdoor “boot camp” fitness program (the “Program”). I the undersigned, acknowledge, recognize, and agree that:

1. I release, waive and forever discharge Fitness Funatics, LLC, an Arizona limited liability company, DBA Fitness Funatics Boot Camp, its officers, members and employees, the City of Chandler and Maricopa County (collectively, the "Released Parties"), from any and all loss, damage, claim, expense, liability or obligation of any kind or nature, including without limitation attorneys' fees, whether at law or in equity, and whether caused by negligence or otherwise, arising from or related to participation in the Program;

2. I understand and recognize the advice given to me by any staff, employee or trainer of Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp is to educate and train me on physical exercise and nutrition, but is not guaranteed to produce any type of results, whether positive or negative;

3. I understand that any staff, employees or trainers of Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp are not medically licensed and are not trained in any way to provide medical advice or diagnosis of a medical condition. I acknowledge that if I am experiencing any sensation out of the ordinary relating to my participation in the Program with Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp, I will contact my physician immediately. I understand and acknowledge that fatigue and physical injury are inherent risks in all types of physical exercise, and that strenuous exercise such as jogging, running, biking, rowing, calisthenics, aerobics and/or lifting weights may cause me to suffer fatigue, injury or even death and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist;

4. I hereby represent and warrant to Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp that I am physically capable of participating in the program without injury and that I am not aware of any physical illness or condition that could increase my risk of injury during such participation. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation in the Program;

5. I willingly agree to comply with the stated and customary terms and conditions for participation in the Program. If, however, I observe any unusual or significant danger or hazard during my participation in the Program, I will remove myself from any such participation and use reasonably necessary efforts to bring the danger and hazard to the attention of the nearest supervisor immediately.

6. I authorize the Released Parties to act in my behalf in accordance with their reasonable judgment in case of an emergency and, further, I agree to assume full responsibly for all expenses, medical or otherwise, resulting therefrom, with the understanding that the Released Parties have not and shall not be deemed to have assumed any responsibility or obligation to provide financial or other assistance in the event of any injury or illness;

7. I understand that this release and waiver discharges the Released Parties from any liability or claim with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Program, whether or not caused by the Released Parties or any other party, and whether by reason of their negligence or otherwise, including without limitation any negligent failure to supervise and/or provide adequate facilities or equipment; and

8. I further agree to indemnify, defend and hold harmless the Released Parties from and against any and all loss, damage, claim, expense, liability or obligation of any kind or nature, including without limitation attorneys' fees, whether at law or in equity, and whether caused by negligence or otherwise, arising from or related to my participation in the Program and incurred and/or caused by the undersigned, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND ACKNOWLEDGE THAT NO REPRESENTATIONS, STATEMENTS OR AGREEMENTS HAVE BEEN MADE SEPARATE AND APART FROM THIS WRITTEN AGREEMENT. I UNDERSTAND ITS TERMS AND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY, FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, SIGNING WHERE INDICATED BELOW.

Please INITIAL the following - * fields are required:

By typing my initials in the box, I signify that I have read and agree with all of the above RELEASE AND WAIVER OF LIABILITY; ASSUMPTION OF RISK.

I attest that I am 18 years or older.*

I attest that I am physically fit to participate in a group outdoor fitness program and assume all risks associated with this program instructed through Fitness Funatics, LLC, DBA Fitness Funatics Boot Camp.*

I understand there is a no refund policy and camp fees cannot be used towards any other products or services provided by Fitness Funatics Boot Camp.*

I agree to show up for Boot Camp every day 5-10 minutes before Class start time.*

I agree to bring with me an exercise mat, sweat towel and water.*

I will be a positive and HaPpY camper who wants to be FiT and have FuN!*

I will not whine about the heat because it’s a “DRY” heat!*

I understand that diet & nutrition will affect my fitness goals and performance during boot camp.*

I agree not to discuss where there is the best Happy Hour or Chocolate Fudge Sundae in town!*

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 & after photos will not be used for any promotional purposes unless I give written authorization.*

I agree not to bring my children with me as there are no babysitting services provided by FFBC.*

By clicking this checkbox, I signify that I have read and agree to all Terms and Conditions listed in this registration form.*

By entering your name here, you signify that you are willingly affixing your signature electronically to this Registration Form and Release and Waiver Release and Waver of Liability; Assumption of Risk.*

You will receive a confirmation email & camper packet within 48 hours of your Registration. Click Ctrl-P to print this form prior to submitting.