Register

To register, complete and submit form below.

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Birthday:

Age:

Email:

Person to contact in case of an emergency:

Name:

Phone Number:

Please answer yes or no to the following questions. If you answer yes to any of the questions please type the number below and give a complete explanation. Answering yes to a question does not automatically remove you from the program. If at any time an answer were to change please notify your fitness trainer immediately.

1 - Has a doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

select Yes No

2 - Do you feel pain in your chest when you do physical activity?

select Yes No

3 - In the past month, have you had chest pain when you were not doing physical activity?

select Yes No

4 - Do you lose your balance because of dizziness or do you ever lose consciousness?

select Yes No

5 - Do you have a bone or joint problem that could be made worse by a change in your physical activity?

select Yes No

6 - Is a doctor currently prescribing medication (for example, a fluid pill) for your blood pressure or heart condition?

select Yes No

7 - Do you know of any other reason why you should not do physical activity?

select Yes No

This questionnaire is intended for the use of individuals between the ages of 15 - 69. 
If you are pregnant or have not been released from your doctor’s care due to a pregnancy please notify your instructor. 

If yes to any of the above please explain:

I hereby give informed consent to engage in a series of procedures relative to completing a written medical/ health history, taking a battery of exercise tests and participating in a variety of physical activities. The purpose of the testing is to obtain the results of my level of physical fitness and health status. All exercise testing and physical activities will be supervised and monitored by a certified personal trainer. These activities will include but are not limited to: walking, running, weight training, and callisthenic exercises performed in an appropriate setting.

I understand there exists the possibility that certain detrimental physiology changes may occur during exercise and exercise testing. These changes could include heart related illness, abnormal heartbeats, abnormal blood pressures, and in rare instances, a heart attack. If abnormal changes were to occur, I understand that the staff has been trained to recognize symptoms and will take the appropriate action, including administrating CPR and First Aid when needed.

I have read this form and understand that there are inherent risks associated with any physical activity and recognize it is my responsibility to provide accurate and complete health/medical history information. Furthermore, it is my responsibility to monitor my individual physical performance during all physical activities.

In the event of a medical problem, I further recognize that any medical care that may be required is my personal financial responsibility.

Registration Type : selectBoot CampersOn-Line TrainingPersonal TrainingRBW Couch 2 5k

Camp Time (preferred): select00:00 am - Personal Training 5:30 am - The Zone 8:00 am - The Zone 5:30 pm - The Zone

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