To secure your spot, full Fill out the registration form below
 completion of the registration Fill out the medical history form below
 forms and payment is required. Read RELEASE and indicate agreement.  
Thank you.
 Submit and choose PAYPAL ONLINE PAYMENT  
Full Name:
Address:
City:
Postal Code:
Profession:
Date of Birth:
I'm signing up for this camp:
Click For Boot Camp Calendar 

GST REG# 86592 6083 RT0001
3-Day Camp (M,W,F)            = $229 + GST = $240.45
5-Day Camp (M,T,W,Th,F)     = $349 + GST = $366.45
This is my first camp:
If NO, when was the last camp attended:

Emergency Contact & Phone:
Your Home Phone:
Work Phone:
Fax Number:
E-mail Address:
I rate my current fitness level as a:
 (1-10), ten being high
My main goal is to:
I heard about Boot Camp:


Medical History Form           

1. Are you allergic to any medication
   (aspirin, penicillin, sulfa, etc.)?
If "yes", please list allergies:   
2. Do you take any prescribed medication on a
    permanent or semi-permanent basis?
If "yes", describe:
3. Do you have a seizure disorder (epilepsy)?
If "yes", 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)?
If "yes", list Medications:
7a. Do you have or have you ever had
      the following diseases? 		 
Heart Disease:
Lung Disease
Kidney Disease
Liver Disease
7b. Are you currently pregnant?
If "yes", how long & any complications:
8. Do you have asthma?
 
If "yes", list Medications:
9. Have you ever had a severe neck injury?
If "yes", describe:
10. Have you ever been knocked out?
If "yes", describe:
11. Do you wear glasses or contact lenses?
 
12. Have you had a broken bone or fracture
     in the past 2 years?
If "yes", describe:
13. Have you ever injured your back?
If "yes", 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?
If "yes", describe:
16. Do you have other physical conditions
      which cause pain?
Describe:
17. Have you had any accidents or major surgery
      that may limit your exercise capability?
      If yes, please describe: 
Describe accidents or major surgery:
18. What are your goals for the next
     three months?      		  Describe your goals:

19. Have you had your body fat tested?

If yes, what percent is it?
20. Are you training for a specific event?
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 My Adventure Boot Camp Inc., its officers, affiliates, and executors in addition to the City of Vancouver, Executive Lifestyle, Temple Fitness and Pro FIT Prefessional Fitness Coaching Systems. The purpose of My 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 T’ai Erasmus 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 My Adventure Boot Camp, Inc does not guarantee neither good nor bad will occur nor guarantees the training advice given by My Adventure Boot Camp, Inc. 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, boxing, agility training, running, weight training, obstacle courses, stretching 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, 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 My Adventure Boot Camp, Inc 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 My Adventure Boot Camp, Inc. 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.

BOOTCAMP PROTOCOL: Please Check Off The Following!

I agree that I will not consume alcohol during the month of Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree not to eat or say the words Twinkie, Donuts, Chocolate Bar, Hot-Dog, Potato Chips, 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 agree that I will not speak when the Boot Camp instructor is providing direction, as this slows down the camp pace, is unsafe and is disrespectful to other Boot Campers. Any violation will result in 20 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 a no refund policy and that I cannot transfer partially unused sessions to a following boot camp program, and that My Boot Camp fees cannot be used towards any other products or services provided by My Adventure Boot Camp, Inc.
I understand and accept that the unauthorized solicitation of products or services to Boot Campers is strictly prohibited and will result in an immediate and permanent dismissal from Boot Camp.
I understand and accept that My Adventure Boot Camp reserves the right to refuse service to any individual that may be unsuitable for the Boot Camp Program.
I understand, agree to and accept that I may not use or teach any of the exercises and/or activities learned during Boot Camp for revenue purposes, and that legal action may be taken against me, unless I have undergone special instructor training and received written authorization from My Adventure Boot Camp.
I will remember to set my alarm and be at camp on time.

BY PRESSING THE SUBMIT BUTTON BELOW, YOU ARE AGREEING TO ALL OF THE ABOVE TERMS.  A SIGNATURE TO THIS EFFECT WILL BE REQUIRED AT YOUR INITIAL EVALUATION.