Personal Training, Fitness Boot Camp, Fitness Retreats, Fitness Vacations, Boot Camp Exercise, Brea BOOT CAMP

Boot Camp Registration

RETURNING BOOT CAMPERS: CLICK HERE FOR SHORT FORM

You now have 2 options:
A. You can print this form and send it in with payment by mail - or fax to 714-693-1171, or
B. Fill out this online form to register "secure" immediately via internet.
We cannot guarantee your space will be reserved if you do not supply us with payment information on this form. You may send a check with your printed registration form, but it must be received at least one week before camp begins. Please Email us with any questions.
Thank you!

If paying by check, please make check out to:
ADVENTURE BOOT CAMP or Brea ABC
Adventure Boot Camp
2826 E. Imperial Hwy.
Brea, CA 92821-6714

You will be notified to schedule your pre-camp evaluation (if needed for your program).
If first camp, please fill out ENTIRE form. Returning campers may skip medical questions if there are no changes.

Name

Mailing Address
match credit card

City

State

ZIP

*Discount Code:
(If applicable)

*Discount Name:
*One discount per camper

Physical address if different from above

Profession

Date of Birth

(mm/dd/yyyy)

Phone Number

Work Number

Cell Number

Email Address (Required: Important Camp Email sent!)

Retype Email Address:

I rate my current fitness level as a (1-10), ten being high.

How did you hear about us?

New Campers Only: Did a current camper refer you?

My main goal is:

This is my first camp: Yes No

If you answered "no", when was the last camp you attended:

Name of Emergency Contact & Phone Number

Which location are you signing up for?

Which program are you signing up for?

Please select days and price:
NOTE: Evening classes are Monday through Thursday only (no Fridays)

All MORNING 4-day campers, indicate your day off:
All MORNING 3-day campers, select your days:
6:30 EVENING 3-day campers, select your days:

Notes:

5-day campers make double progress
YOU CAN DO IT!

Form of payment:

Cash or check payments must be received before camp fills or prior to expiration of any special pricing discounts. Please use mail/fax form below.

Note: If paying by CHECK, please click here to be redirected to the mail/fax form.
*Please note - we cannot guarantee your reserved spot until payment is received.

PLEASE verify all credit card numbers are entered before sending.

Credit Card Number:	no spaces	Exp. Date:	/
Name on Credit Card:		*CVC Code:**	(security code)

*Visa and MasterCard: In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.
American Express: On the front of your card next to your main credit card number look for a 4 digit code. This 4 digit number is the Card Security Code.

If paying by check, please make check to:
ADVENTURE BOOT CAMP or BREA ABC

MAILING & OFFICE ADDRESS:
Adventure Boot Camp
2826 E. Imperial Hwy.
Brea, CA 92821-6714

Are you adding Nutrition 101 $50 for 4 weeks? Yes No
(Your results will triple if you are eating healthy, well-balanced meals throughout the 4-week camp)

MEDICAL HISTORY (Returning Campers: You need only to 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 diabetes?

List Medications:

4. Do you have High Blood Pressure (hypertension)?

List Medications:

5. Do you have asthma?

List Medications:

6. Describe any severe injuries within the past 5 years or that may still cause pain:

7. Detail any surgical procedures:

8. Have you had your body fat tested?

If yes, what percent?

9. 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 Adventure Boot Camp for Women, its officers, trainers, affiliates and executors in addition to the City of Brea, the City of Fullerton, the City of La Habra, Brea Olinda Unified School District, Fullerton School District, La Habra School District, The County of Orange, and any and all other private and public locations for camps. The purpose of Adventure Boot Camp for Women 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 Suzanne Stringfellow and any Certified Personal Trainer employed as an instructor for Adventure Boot Camp 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 Adventure Boot Camp for Women does not guarantee neither good nor bad will occur, nor guarantees the training advice given by Suzanne Stringfellow 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. Videography and photography may be taken at various camp locations which may appear on TV, web video, print or any other digital format. When possible, the camp participants will be told in advance of the days in which any photography or videography will be done. "Before & after" photos will not be used for any promotional purposes unless written authorization is granted.

5. 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 inherent dangers of the natural elements, 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 waives, releases, discharges and agrees not to sue from any liability of death, disability, personal injury, or action of any kind, Suzanne Stringfellow, Brea Adventure Boot Camp for Women 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 Suzanne Stringfellow, 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.

Initial the following:

I agree not to: 1) Use foul language during Boot Camp. 2) Not to whine! 3) Gab incessantly during camp. *Many of you have friends at camp. Please be considerate of others. I have had many complaints from hard-working ladies about the "gabbers." This is very disrespectful to other campers who are obviously working a lot harder than someone who has the energy to gab! Please work your butt off during camp & meet for coffee later! ** Violations may result in 20 pushups 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 and camp fees cannot be used towards any other products or services provided by Brea Adventure Boot Camp.
I will remember to set my alarm (2 alarms is helpful - cell phones are a good backup) and be at camp on time. Any violation will result in either 20 push-ups, 20 abs crunches, or 20 dips per occurrence - instructors choice! However, "things" happen so always come, even if you're late - don't ruin that perfect attendance! And a few pushups are good for you!
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 director.
I UNDERSTAND THAT I AM SIGNING UP FOR 4 WEEKS - NO EXCUSES! If you have a pre-planned trip and know you will miss a couple days of camp, you MUST let your instructor know before you sign up in order to receive up to 2 days credit towards a future camp. We cannot credit towards injuries occurring out of camp.
And lastly, I WILL NOT stop coming to camp completely. I am signing up for 4-weeks and I promise to not get lazy and not finish camp! It's only 4-weeks, I CAN DO IT! (Plus, there are special "prizes" on the last day of camp for perfect attendance!)

By clicking on the SUBMIT button below, you agree to all of the terms above and acknowledge that you filled out this form with complete honesty.

____________________
Signature
____________________
Printed Name
____________________
Date

*Note: If you are unable to attend camp due to circumstances out of your control, we can offer you a refund if you notify us prior to your session start date. If we are notified after your session begins, we can only give you a credit towards another boot camp. There is no cash refund.

I agree to all Terms and Conditions listed above

For More Information, Contact us at (714) 455-2110 or e-mail Suzanne@BreaBootCamp.com