Healthy and Fit Boot Camp, Princeton NJ

Registration for Healthy and Fit Boot Camp

Registration Form
Personal Information (Read Our Privacy Statement)

First Name:

Last Name:

Age:

Date of Birth: mm/dd/yyyy

Address:

Street Address

City

State

Zip Code

Email Address:

Telephone Number:

In case of emergency, whom may we contact?

Telephone Number (Emergency Contact):

How did you find out about our program?

Active History

Yes

Are you presently involved in a regular exercise program?

If yes, please list activity, duration and frequency (example: power walk for 30 minutes, 4 times per week):

Sedentary

Moderately Active

Highly Active

How active do you consider yourself? (Please choose one)

Good

Fair

Poor

Please describe your knowledge of exercise and fitness? (Please choose one)

Medical History

Check any conditions you currently have or have had in the past five years.

			Heart Attack; Coronary Bypass

			Diabetes

			Foot Problems

			High Blood Pressure


			Low Blood Pressure


			Neck Problems

			Irregular Heart Beats

			Swollen, Stiff, or Painful Joints

			Anemia


			Migraine/Recurrent Headaches


			Shoulder Problems


			Bronchitis

			Back Problems


			Epilepsy or Seizures

			Unusual Shortness of Breath

			Broken Bones


			Emphysema

			Limited Range of Motion in Joints

			Light-Headedness or Fainting

			Fatigue or Lack of Energy

			High Cholesterol


			Asthma



			Hernia

			Trouble Sleeping


			Arthritis


			Bursitis

			Chest Discomfort


			Other (explain below)

Other (please explain):

Please list any prescription medications you are now taking.

Please list any over-the-counter medications you are now taking.

Please list any dietary supplements you are now taking.

Health and Fitness Goals

Please check specific health and fitness goals that you want to achieve.


		Improve Strength


		Increase Energy


		Improve Flexibility


		Reduce Stress


		Improve Endurance


		Improve Diet/Eating Habits

		Improve Muscle Tone and Shape


		Build Immune System


		Lose Weight


		Training for a Specific Sport or Event


		Gain Weight/Muscle

		Additional Goals (please list below)

Additional Goals (please explain):

I do hereby state that I have, to the best of my knowledge
and belief, given a correct and accurate history report.

I agree to participate in a health and fitness program given by Healthy and Fit Boot Camp.  During your exercise program, every effort will be made to assure your safety.  However, as with any exercise program, there are risks, including increased heart stress and the chance of musculosketetal injuries.  In volunteering for this program, you agree to assume responsibility for these risks and any possibility for personal damage.  You also agree that, to your knowledge, you have no limiting physical conditions or disability that would preclude an exercise program.

I understand and agree that if I have any medical condition that it is my responsibility to check with my physician for any contraindications with any foods, phytochemicals, supplements, nutrients, or exercise in this program.  By agreeing to these terms, you accept full responsibility for your own health and well being and you acknowledge an understanding that no responsibility is assumed by the leaders of the program.

I understand and agree the health and fitness program from Complete Health Network is not intended to treat illness, disease, or any medical condition.  This program is designed to promote a healthy lifestyle and does not guarantee an illness-free life.  Many complex and uncalculated conditions affect the overall well being of an individual.

I agree to waive, release, remise and discharge Healthy and Fit Boot Camp, Complete Health Network, Inc., officers, agents, representatives, and employees of any and all claims, demands, actions or damages resulting from my participation in Healthy and Fit Boot Camp.

By registering for the boot camp you are agreeing to the above terms and conditions.

I have read and agree to the terms and conditions
in the pane above.

Healthy and Fit
Boot Camp

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Community Park
Princeton, NJ

Get Healthy,
Get Fit

Mon, Wed, Fri - 6:30am
Women Only

Mon, Wed, Fri - 8:00am
Coed

Measurable Results
Guaranteed for $1

Get Healthy, Get Fit Special

Spots fill up quickly so don't
miss out. Register Today

2 Weeks of Fat
Burning, Energizing
Workouts

Healthy & Nutritious
Diet Program