Adventure Boot Camp for Women - San Diego, Scripps Ranch, North County, Rancho Bernardo

Registration is easy and can be done in 2 steps!

1) Reserve your place in camp by paying via credit card on our calendar page. Click Here to Pay by Credit Card.

2) Complete our on-line registration form:

-----> New Campers: Scroll down and use the Form below

-----> Returning Campers: Click Here to Use Our Returning Camper Form

* If you would prefer a printable version of the registration form, it is available by clicking here.

Camp Start Date

Date of Birth (required)

First Name

Last Name

Street Address

City State

Home Phone

Cell Phone

Job Title

Work Phone

Emergency Contact Name

Emergency Contact Phone

On a scale of 1-10, 10 being the highest elite athlete, I rate my fitness level as

My main fitness goal is

My fitness goal in this camp is

How did you hear about boot camp?

If by referral, please provide their name

Attendance Options

Payment Options (select one)

MEDICAL HISTORY QUESTIONAIRE

All "YES" answers require a written explanation in appropriate section below

If you are unsure about the definition of any terms in this form, please call us to clarify. Do not assume.

1	Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)? Yes No
2	Do you take any prescribed medication on a permanent or semi-permanent basis? Yes No
3	Do you have a seizure disorder (epilepsy)? Yes No
4	Do you have diabetes; Type I (IDDM) or Type II (NIDM)? Yes-Type I Yes-Type II 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 Heart Disease? Yes No
8	Do you have or have you ever had Lung Disease? Yes No
9	Do you have or have you ever had Kidney Disease? Yes No
10	Do you have or have you ever had Liver Disease? Yes No
11	Do you have or have you ever had asthma? Yes No
12	Do you have or have you ever had severe neck injury? Yes No
13	Have you ever had been knocked out? Yes No
14	Have you had a broken bone or fracture in the past 2 years? Yes No
15	Do you wear glasses or contact lenses? Yes-Glasses Yes-Contacts No
16	Have you ever injured your back? Yes No

17	Do you have back pain? Yes No

18	Have you had knee pain in the past 2 years that has disabled you for longer than a week? Yes No
19	Do you have other physical conditions, which cause pain? Yes No
20	Have you had any surgical procedures? Yes No
21	Have ever had your body fat tested? Yes No
22	Are you training for a specific event? Yes No

Please explain all "YES" answers below. Please reference the question number.

NOTICE:
It is wise to seek your doctor’s advice BEFORE beginning any health/fitness/nutrition program!

Informed Consent, Waiver, and Release Agreement

This waiver and release is entered into between the undersigned and XYZ Adventure Boot Camp / Inc. its instructors, officers, affiliates, and executors.

The purpose of the Adventure Boot Camp Program offered by Small Steps Fitness, LLC 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:

Acknowledges that the instructor is not a physician and is not trained in any way to provide medical diagnosis or any other type of medical advice.
Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Adventure Boot Camp and Small Steps Fitness, LLC does not guarantee neither good nor bad will occur, nor guarantees the training advice given by Adventure Boot Camp and Small Steps Fitness, LLC or its instructors will produce good nor bad results.
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.
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 and 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, Adventure Boot Camp, Small Steps Fitness, LLC, its instructors, officers, affiliates, and executors 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 no representatives of Small Steps Fitness, LLC nor anyone else has 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.

PERFORMANCE PLEDGE

In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have established the following policies to which you will need to adhere.

Please read and check each one.

I agree that I will not consume alcohol during the month of Boot Camp.

I agree not to use foul language during Boot Camp.

I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp.

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.

I will arrive at camp ON TIME.

(Any violation of the above statements 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 that my "before & after" photos will not be used for any promotional purposes unless I give written authorization.

I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if, for reasons beyond my control, I am not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services provided by Small Steps Fitness, LLC.

AUTHORIZATION

I agree to all terms and conditions listed above.

Please enter your full name in the box below. This is your electronic signature.

Date

Press Submit when you're ready to get fit!!

For more information, please call us at (858) 776-8401 or email

Sarah@SmallStepsFitness.com