Step II: Camper Info

Please take a moment to provide your contact information and answer a few brief questions regarding your current level of fitness, exercise program and health history.

All information is strictly confidential.


2010 Boot Camp Challenge
at Seminole Studio
Registration Form
I would like to train on (choose all that apply):
Tuesdays 6:45 pm  Wednesdays 10:00 am  Saturday 9:00 am
Personal Information

First Name:

Last Name:

Email:

Sex:

Address:

Age

City:

State:

Zip:

Best Day Phone:

Best Evening Phone:
Health Information

Do You Smoke?

No  Yes

Are You Overweight?

No  Yes

If So, By How Many Pounds?

Are you currently involved in an exercise program?

Yes  No

If yes, please describe:

If yes, how long have you been involved in the program?

If not, how long has it been since you were involved in a regular exercise program?

In what kind of physical shape do you consider yourself?

Would you consider yourself a:

Walker  Walker/Jogger  Jogger/Runner

Currently can you walk, jog, or run two miles?

Yes  No

Do you know of any muscular or skeletal issues that could be could be complicated due to an active exercise class?

Do you have any risk factors such as high blood pressure that could be complicated due to an active exercise class?

Do you have any risk factors such as high blood pressure, heart disease, asthma, etc?

Are you currently under a doctor's care for any medical issue?

Are you pregnant?

Yes  No

Have you recently given birth?

Yes  No

If yes, please provide date of delivery:

What was the delivery method?

Did you experience any complications during your delivery or recovery?

Yes  No

If yes, please describe:
Emergency Contact Info:

Name:

Phone:

Relation:
Additional Info:

How did you hear about Fun Fitness Boot Camp?

Other:

Are you taking this class with a significant other or friend?

If yes, Name: