Boot Camp Registration
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Bootcamp Location:
Registration Type:
 
Please check off which days you plan to attend classes. This does not commit you to the day.
 
Mon Tue Wed Thu Fri Sat
6:00pm
 6:15am 6:00pm 6:15am   9:30am
6:00pm 7:00pm 6:00pm 7:00pm   8:30am
7:00pm   7:00pm 7:00pm    
 
Select Your Package:
4 Week Session
$179 2 Sessions Per Week for 4 Weeks
$199 3 Sessions Per Week for 4 Weeks
$229 Unlimited (up to 5x per week) for 4 Weeks
     
3 Month Session
$477 2 Sessions Per Week for 3 Months
$537 3 Sessions Per Week for 3 Months
$597 Unlimited (up to 5x per week) for 3 Months
   
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Personal Medical History - Step 2

History No Yes Details
Asthma
Bone or Joint Injury
Poor Circulation
Arthritis
Back Problems
Recent Surgeries
Medication
Ulcers
Hernia
High Blood Pressure
Heart Condition
Diabetes
Do you smoke?
Do you drink alcohol?
Any chronic illness?
Recent/Current Pregnancy
Other areas of concern...

Family Medical History

History No Yes Details
Smoking
Diabetes
High Blood Pressure
High Cholesterol
Other areas of concern...
   
* Emergency Contact:
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Physician:
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