Boot Camp Registration Form and Release
Thank you for registering for Boot Camp Las Vegas. Please complete and submit the form below. Once we have received your completed registration form and payment, we will send you a confirmation by email with additional information. (If you are returning for a second session, just go to the payment page. No need to re-register!)

Required fields are marked in bold.

Just Need to Make Your Payment?

Receiving an Error Page? Go to Step 2 (Release Form)
(Registration form will go through even though you receive the error page. Just click submit, then come back to this page and click the above link.)

  First Name
  Last Name
Address
City
State
Zip
Phone
  Email
   Date of Birth  /  /  
Gender
  Is this your first camp? If No, Camp Attended:
Emergency Contact
Contact's Phone
    Fitness Level
(1-10, 10 being the best)
How did you find us? Or Referred by:
My main goal is to:
First Boot Camp class you will attend
(after the first day you can go to whichever time and location you want)
  Date you will start bootcamp  
     
    Number of days per week (1-5)
Comments

MEDICAL HISTORY
If you are returning and have no medical changes, the medical section below does not need to be completed. All agreements remain the same.
NOTICE: It is wise to seek your doctor's advice before beginning any health/fitness/nutrition program!
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
Medications: 
  
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
Medications: 
    
3. Do you have a seizure disorder (epilepsy)?
  
4. Do you have diabetes adult or juvenile?
Medications: 
  
5. Have you ever been found to be anemic (low blood count)?  
6. Do you have high blood pressure (hypertension)?
Medications: 
  
7. Do you have or have you ever had the following diseases?  
Heart Disease
  
Lung Disease
  
Kidney Disease
  
Liver Disease
  
8. Do you have athsma?
Medications: 
  
9. Have you ever had a severe neck injury?
Describe: 
  
10. Have you ever been knocked out?
Describe: 
  
11. Do you wear glasses or contact lenses?  
12. Have you had a broken bone or fracture in the past 2 years?
Describe: 
  
13. Have you ever injured your back?
Describe: 
  
14. Do you have back pain?
 
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
Describe: 
  
16. Do you have other physical conditions which cause pain?
Describe: 
  
17. Detail any surgical procedures
  
18. If you have had your body fat tested, what is you percent body fat?  %  
Click 'Submit', and go to the Release Form