Brea Adventure Boot Camp Program Fitness Events in Brea Brea Boot Camp Brea Bootcamp History of Fitness Boot Camps Common Questions about Adventure Boot Camp Brea Fitness Boot Camp Bootcamp Photos

Boot Camp Registration Form
Returning campers may use short form

You now have 2 options:
A. You can
print this form and send it in with payment by mail...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. 
Please Email us with any questions. Thank you!

Notes:

 
If paying by credit card, please fill out the form below and hit "Submit"
Please fill out ENTIRE form. 
Returning campers may skip medical questions if there are no changes.
*NAME
(First & Last)
*Mailing Address
 match credit card
*City
*State
*ZIP
Discount Code:
(If applicable)
   
Physical address if different from above
Profession
*Date of Birth (mm/dd/yyyy) 
*60+ years or pregnant?  Good for you - you can do it!  We respectfully request clearance from your doctor prior to the first day of class. Please bring a note to your pre-evaluation.  Thank you.
*Phone Number Work Number
Cell Number  

*Email Address
      (Required)

 Retype Email Address: 
I rate my current fitness level as a (1-10),
10 being high.
How did you hear about us?    If "Other," indicate how:
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 did you last attend camp:

Name of Emergency Contact

& Emergency Phone Number
 

   
*



 If you are an A.M. "4-day" camper, please choose your day off.  P.M. campers excluded.

All 3-day campers, please choose your 3-day preference!

6:30 p.m.  classes are held Monday through Thursday only (no class on Fridays)

*NOTE: If you are not attending full time, it helps us and YOU if you attend on your chosen days.  However, we understand "things" happen. 
If you need to switch days because of work, kids, vacations, etc., notify your instructor the day before or email Suzanne@breabootcamp.com.

 

Form of payment:

PLEASE DO NOT REGISTER WITHOUT PAYMENT INFORMATION. 
PAYMENT MUST BE RECEIVED PRIOR TO FIRST DAY OF CLASS - THANK YOU.
If paying by CHECK, payment must be received by the Saturday prior to first day of class. 
Envelopes may be dropped through the mail slot at Boot Camp office: 2826 E. Imperial Hwy., Brea, Ca.

CLICK HERE for printable form
Credit Card Number:

no spaces   
Please verify your number before sending

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.

CHECKS MUST BE RECEIVED BY SATURDAY PRIOR TO FIRST DAY OF CLASS

MAILING & OFFICE ADDRESS:
Adventure Boot Camp
2826 E. Imperial Hwy.
Brea, CA 92821-6714
CLICK HERE for printable form


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?
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, El Rancho Charter School, The County of Orange, and any and all other private and public locations for camp sites. 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,  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.

I agree: 1) Not to use foul language during Boot Camp. 2) Not to whine, complain or use the word "can't" in class! 
3) Not to say Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake
4) Not to gab incessantly during camp. *Many of you have friends at camp.  Please be considerate of others.  We occasionally have complaints from campers about "gabbers."  This is very disrespectful to other campers who are obviously working harder than someone who has the energy to gab! 

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  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 THE FULL SESSION - 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.

I understand there is no refund after the camp I have registered for begins. No exceptions – don’t ask. If you are unable to begin the camp you have registered for you may cancel before camp begins; there is a $50 processing/cancellation fee.

And lastly, I WILL NOT stop coming to camp completely.  I promise to attend faithfully be it rain or shine, sleep or no sleep, good mood or bad mood!  I CAN DO IT!  (There's a drawing 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
 

I agree to all Terms and Conditions listed above
 

 

For More Information, Contact us at (714) 455-2110 or e-mail Suzanne@BreaBootCamp.com
Program | Calendar | Registration | About Us | Our History | Common Questions | Photos | Contact Us | Testimonials | Home