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1 To 1 Fitness

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Womens's Adventure Fitness Boot Camp in Rancho Santa Margarita, Orange County, California.

Boot Camp
Register Now!
630-640-0467

Boot Camp Registration- Make Sure You go to the Payment Page

Fox Valley Adventure Boot Camp Class
REGISTRATION

You now have 2 options:
A. You can print this form and send it in with certified check payment by mail
B. Register Online
Fill out the online form below to register via internet. Click on Submit to go to the payment page.
Payment Page: Pay via Paypal. Choose your class and finish your online registration. A PayPal account is not required to pay via PayPal.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment. Payments are due 2 weeks prior to class starting.

1 to 1 Fitness Inc.
2642 Havens Dr
West Chicago IL, 60185
merlin@FVBootCamp.com
Phone: (630) 640-0467

If you choose option B: Fill out the form below and Click on SUBMIT.

You will be notified to schedule your pre-camp evaluation (if needed for your program).
Name
Address
City
State
Zip code
Profession
Location you are registering for
Date of Birth	(mm/dd/yyyy)	Age
Phone Number		Work Number
Fax 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?: Blast fax , friend , Ad		Please specify publication / website / friend ,key words searched 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
What is the name of the program you are joining and date? \| Choose your event time/price from the 2nd pull down menu.
IE: St Charles, Geneva,Batavia,Wheaton
Form of payment:
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! RELEASE This release is entered into between the undersigned and Fox Valley Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the Cities of St Charles,Geneva, Batavia,Wheaton,and Lincolnshire.The purpose of Fox Valley Adventure Boot Camp 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 Merlin Hahn 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 Fox Valley Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Merlin Hahn including Fox Valley 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. 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 Fox Valley Adventure Boot Camp 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 Fox Valley Adventure Boot Camp including Merlin Hahn 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. Customer client agrees to confidentiality with respect to Fox Valley Adventure Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Fox Valley Adventure Boot Camp. The undersigned agrees to a non-compete within a 50 mile radius of Fox Valley Adventure Boot Camp for a period of 5 years from date of participation. Checkmark the following: I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence. I agree not 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 per occurrence. I agree to show up for Boot Camp 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 per occurrence. 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 receive a credit (for unused portion of camp) towards a future camp. In addition any unused sessions become null and void after 90 days if I'm not able to complete the one I originally joined. Camp fees can not be used towards any other products or services provided by Fox Valley Adventure Boot Camp. I will remember to set my alarm and be at camp on time. I understand that diet and nutrition will effect my fitness goals and performance during boot camp. I will bring a positive attitude, and expect to have fun
I agree to all Terms and Conditions listed above Electronic Signature Date (MM/DD/YYYY)

For More Information, Contact us at 630 640 0467 or e-mail merlin@FVBootCamp.com