Womens's Adventure Fitness Boot Camp in Pembroke Pines, Broward County, Florida. Women's Adventure Fitness Boot Camp in Broward County, bootcamp for women, adventure boot camp, womens fitness program, womens weight loss, exercise camp, womens camp, exercise, workout programs, outdoor exercise

 

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Womens's Adventure Fitness Boot Camp in Broward County, Florida.

Broward County Boot Camp
(Weston & Pembroke Pines Locations)
REGISTRATION
You now have two options:   
1. You can print this form via adobe pdf and send it in by fax or mail, with your payment,

   or
2. Register immediately below.
NOTE: We cannot guarantee your space will be reserved if you do not continue through to the store for secure online payment.

Broward County Adventure Boot Camp
12330 SW 53 Street # 708
Cooper City, FL 33330
Jim@BrowardBootCamp.com
PH:    (954) 438-4744
FAX: (954) 449-0416

Jim@BrowardBootCamp.com

 


Name:
Email Address:
Phone Number:
Work Number:
Fax Number:
Address:
City:
State:
Zip Code:
Profession:
Date of Birth:
I rate my current fitness level as a: (1-10), with 10 being highest.
I was referred by:
Emergency contact and phone number:
Boot Camp Location
CrossFit 12330 SW 53 St # 708, Cooper City, 33330
 
 
MEDICAL:  (If you are a returning camper, only complete the sections that have changed.)
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)? yesno
 2. Do you take any prescribed medication on a permanent or semi-permanent basis? yesno
 3. Do you have a seizure disorder (epilepsy)?  yesno
 4. Do you have diabetes Adult or Juvenile?  yesno
List Medications:  
5. Have you ever been found to be anemic (low blood count)?  yesno
6. Do you have High Blood Pressure (hypertension)?  yesno
List Medications:
7. Do you have or have you ever had the following diseases?  

Heart Disease: 

yesno

Lung Disease: 

yesno

Kidney Disease: 

yesno

Liver Disease: 

yesno
8. Do you have asthma?  yesno
List Medications:
9. Have you ever had a severe neck injury?  yesno
Describe:  
10. Have you ever been knocked out?  yesno
Describe:  
11. Do you wear glasses or contact lenses?  yesno
12. Have you had a broken bone or fracture in the past 2 years?  yesno
Describe:  
13. Have you ever injured your back?  yesno
Describe:
14. Do you have back pain?  yesno
Never  Occasionally  Frequently with vigorous exercise or heavy lifting.
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? yesno
Describe:  
16. Do you have other physical conditions which cause pain?  yesno
Describe:
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested?  yesno
 If yes, what percent is it?
20. Are you training for a specific event?  yesno
If yes, explain:
 NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program! 


RELEASE
This release is entered into between the undersigned and 911 FITNESS, its officers, subsidiaries,
affiliates, and executors in addition to the City of Pembroke Pines, Weston, and the county of Broward.
The purpose of 911 FITNESS 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 Jim Sayih, LEAD Trainer for 911 FITNESS, 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 does not guarantee neither good nor bad will occur nor guarantees the
    training advice given 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. 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 elements of a natural environment, 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 waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind Jim Sayih or 911 Fitness 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 911 FITNESS and Jim Sayih, 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.

By typing your name in this field, you are hereby giving a digital signature.
Signature
Today’s Date: 
Comments/Questions:

For More Information, Contact us at (954-438-4744) or e-mail Jim@BrowardBootCamp.com
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