Women's Adventure Fitness Boot Camp in San Jose, bootcamp for women, adventure boot camp, womens fitness program, womens weight loss, exercise camp, womens camp, exercise, workout programs, outdoor exercise

San Jose Adventure Boot Camp Registration

FIRST TIME CAMPERS: Please complete the ENTIRE form and CLICK ON THE SUBMIT BUTTON. You will then select your camp on the next screen and make your purchase.

RETURNING CAMPERS: Please fill out all sections marked with "*" and then CLICK ON THE SUBMIT BUTTON. You will then select your camp on the next screen and make your purchase.

You will be notified to schedule your pre-camp evaluation (if needed for your program).
*Participant Full Name
*Billing Address
*City
*State
ZIP (Billing*)
Profession
Country
*Date of Birth	(mm/dd/yyyy)
*Phone Number (billing)		Work Number
Cell Number
*Email Address
I rate my current fitness level as a (1-10), ten being high.
I was referred by:
How did you hear about us?: (Please let us know;-)		Please specify publication / website / friend or other referral:
This is my first camp:	Yes \| No	If you answered "no", when was the last camp you attended:
My Main goal is:
Name of Emergency Contact & Phone Number
Which Camp are you joining? \| What Time are you attending? \| Choose your Days/per Week & price from the 2nd pull down menu.
		*please select the correct price for your camp

NOTE: Actual purchase will be made AFTER clicking submit at the bottom of this screen. CAMP PRICING: 4 Week Camp Pricing: $299 (5 days/week) \| $260 (4days/week)\| $199 (3days/week) This option is for those who have other commitments in the early a.m. Since it is only a 4-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out! You can do it!! ) Special 3 Week Mini-Camp Pricing: 5-Day $240,* 4-Day $195, and 3-Day $150. These options are for those who have other commitments in the early a.m. Since it is only a 3-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out! You can do it!! ) NOTE - Mini Camps are ONLY available as listed on the CALENDAR page. Mini Camps for 2010: Campbell C2 & 10-10 "C" is Campbell location. MEDICAL HISTORY (If you are a returning camper, only complete the sections that have changed.)
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
List Medications:
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
List Medications:
3. Do you have a seizure disorder (epilepsy)?
List Medications:
4. Do you have diabetes Adult or Juvenile?
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
List 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 asthma?
List 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. What are your goals for the next three months?
19. Have you had your body fat tested?		If yes, what percent is it?
20. 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! I hereby acknowledge that the following was explained to me and/or agree to the following: 1. Acknowledges that Brett A. Riesenhuber and staff are not physicians and are 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 San Jose Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Brett A. Riesenhuber including San Jose Adventure Boot Camp 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. Undersigned agrees to a non-compete within a 50 mile radius of San Jose for a period of 5 years from date of participation. Checkmark the following: I agree to be coachable/trainable during my 4 weeks of boot camp in order to achieve by health and fitness goals. I commit to give 100% effort to myself and my fitness at each class and the remaining 23 hours per day. 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. Any violation will result in twenty push-ups and one lap per occurrence. I agree to set my alarm and show up for Boot Camp ON TIME every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors. Any violation will result in twenty push-ups and one lap per occurrence. I commit to respect my coach and my peers by not talking while the coach is instructing. If the coach is speaking it is likely information that my peers and I need to hear to make our boot camp experience more safe and effective. I understand that diet and nutrition will effect my fitness goals and performance during boot camp. I choose to commit to eating and drinking foods and beverages that will accelerate my success AND consume no alcohol for my 4 week program. I agree to show up for Boot Camp every day that I have registered for. 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 only receive a credit (for unused portion of camp) towards a future camp that I register for if I'm not able to complete the one I originally joined and notify San Jose Adventure Boot Camp in writing at the time I am no longer able to attend my registered camp. Camp fees can not be used towards any other products or services provided by San Jose Adventure Boot Camp. If you are unable to begin the camp you have registered for you may cancel before camp begins, there will be a $50 cancellation fee. I will bring a positive attitude, and expect to have fun!
I agree to the terms stated above. This agreement also incorporates numerous additional Terms and Conditions as well as an Express Assumption of Risk Agreement and Release of Liability and Indemnity Agreement ("Additional Terms and Conditions"). You must check the box before proceeding and you must view the Additional Terms and Conditions by clicking here. By checking the box and clicking the "Submit" button below, you hereby represent that you have read the Additional Terms and Conditions in its entirety and you specifically acknowledge and agree to be bound by its contents. Electronic Signature Date (MM/DD/YYYY)
- Go to next step: Select Camp Experience!

For More Information, e-mail: SanJoseBootCamp2@gmail.com