Beach Body Boot Camp
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Please fill out the following registration information, health & fitness history and medical release form. We will contact you to gather payment information from you.

Personal Information

First Name *

Last Name *

Address *

City *

Province *

Postal Code *

Date of Birth *

(mm)

(dd)

(yyyy)

Age *

Home Phone *

Cell Phone

Work Phone

Email *

Medical History

Do you have or have you ever been diagnosed with heart disease? *
Yes No

Do you have or have you ever been diagnosed with high blood pressure? *
Yes No

Do you have or have you ever been diagnosed with Asthma or any other condition producing breathing difficulties? *
(If you have Asthma, you must bring your emergency inhaler with you to each workout)
Yes No

Do you have or have you ever been diagnosed with arthritis or any other bone or joint condition that might be aggravated by vigorous exercise? *

Yes No

Do you frequently suffer from heart or chest pains? *
Yes No

Do you often feel faint or suffer from severe spells of dizziness? *
Yes No

Are you over the age of 65 and are unaccustomed to vigorous exercise? *
Yes No

Is there any reason not listed that would prevent you from participating in a progressive exercise program? *
Yes No

* = Required Field

If you answered yes to any of the above questions, please speak to your doctor about your readiness to participate in our programs before joining.

Before starting any exercise program please be certain that you have your doctor’s approval. Should you decide not to obtain your doctors approval, you exercise at your own risk. As your physical trainer, I am not a physician, and I cannot be expected to know whether you are medically suited for such exercise.

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Beach Body Boot CampJOIN

Beach Body Boot Camp
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