BABC & Rivertowns Fitness

Register Here for
BABC & Rivertowns Fitness!

You now have 2 options:
A. You can print this form and send it in with payment by mail
B. Register Online
Fill out the online form below to register via internet.
Mail in your check to

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

If paying by check, please make check out to:
Bucks Adventure Boot Camp
P.O. Box 542
New Hope, Pa. 18938
BucksBootCamp@yahoo.com
Phone: (215) 869-1182

If you choose option A, Print this page and mail it in with payment.
If you choose option B: Fill out the form below and Click on SUBMIT.

Please note: All fields are required.

Camp and Payment Information

What camp are you joining?:

Choose your camp frequency and cost:

Payment

Form of payment

Personal Information

Name

Email

Phone Number

Address

City

Zip

Profession

Date of Birth


Self Assessment & Additional Information

I rate my current fitness level as: (1-10)

Is this your first adventure boot camp:

Last Camp attended:

My Main goal is:

I was referred by:

How did you hear about us?

Name of Emergency Contact

Emergency Phone Number


Medical History

Enter N/A for any section which is Not Applicable for you.
Are you allergic to any medication? List medications:

Do you take any prescribed medication? List medications:

Do you suffer from epilepsy? List medications:

Are you anemic? List medications:

Do you have Diabetes? List medications:

Do you have High Blood Pressure? List medications:

Do you wear glasses or contact lenses?

Do you have Asthma?

Do you have Heart Disease? List medications

Do you have Lung Disease? List medications:

Do you have Kidney Disease? List medications:

Do you have Liver Disease? List medications:

Have you ever had a severe neck injury? Describe:

Have you ever been knocked out? Describe:

Have you had a broken bone or fracture in the past 2 years? Describe:

Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:

Have you ever injured your back? Describe:

Describe any current pain you may be experiencing: Describe:

Do you have other physical conditions which cause pain? Describe:

Have you had any surgical procedures: Describe:

What are your goals for the next three months? Describe:

Have you had your body fat tested? Describe testing and results:

Are you training for a specific event? If yes, explain:

RELEASE
This release is entered into between the undersigned and BABC/RFitness its officers, subsidiaries, affiliates, and executors in addition to the County of Bucks County Pa and Hunterdon County NJ. The purpose of Bucks Adventure Boot Camp/RFitness 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 the trainer's are not a physician's, nor 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 assisting athletes/individuals seeking to reach health/fitness goals, but that BABC/RFitness does not guarantee results.

3. Acknowledges that the undersigned has been instructed that if they feel tired, feel pain or feel unwell, in any way, to cease participating in class and seek medical attention from a physician.

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 Bucks 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 Bucks Adventure Boot Camp/Rivertowns Fitness, it's trainers, have 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 BABC/RFitness and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Bucks Adventure Boot Camp. The undersigned agrees to a non-compete within a 25 mile radius of Bucks County, Pennsylvania for a period of 5 years from date of participation.

I agree not to use foul language or be negative during class . Any violation will result in 10 laps per occurrence!

I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of . Any violation will result in twenty Burpee's per occurrence!

I agree to show up for every day unless it is an excused absence from my doctor or pre-approved with 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 this program, which may be used for promotional/inspirational purpose's and I give my consent for same.

I understand there is no refund policy, though a credit may be issued for unused portion of program towards a future session at discretion of trainer. Program fees can not be used towards any other products or services provided by BABC/RFitness.

I agree to be on time and ready to go!

I understand that diet and nutrition will effect my fitness goals and performance during .

I will bring a positive attitude!

I agree to all Terms and Conditions

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