Triangle Adventure Boot Camp in Raleigh, NC - womens fitness, group personal training
Triangle Adventure Boot Camp Registration
Contact Information
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Last name:
DOB:
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First name:
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Emergency
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Camp & Fitness Information
Camp:
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 Days per Week:
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Fitness Level:
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My main fitness goal is:
 My fitness goal for this camp is:
How did you hear about Triangle Adventure Boot Camp?
If by Referral, please provide their name:
Medical History
YES
 NO
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
3. Do you have a seizure disorder (epilepsy)?
4. Do you have diabetes; Type I (IDDM) or Type II (NIDM)?
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
7. Do you have or have you ever had Heart Disease?
8. Do you have or have you ever had Lung Disease?
9. Do you have or have you ever had Kidney Disease?
10. Do you have or have you ever had Liver Disease?
11. Do you have or have you ever had asthma?
12. Do you have or have you ever had severe neck injury?
13. Have you ever been knocked out?
14. Have you had a broken bone or fracture in the past two years?
15. Do you wear glasses or contact lenses?
16. Have you ever injured your back?
17. Do you have back pain?
18. Have you had knee pain in the past two years that has disabled you for longer than a week?
19. Do you have other physical conditions which cause pain?
20. Have you had any surgical procedures?
21. Have you ever had your body fat tested?
22. Are you training for a specific event?
23.  Please use the box below to explain ALL "yes" answers from above.
Informed Consent, Waiver, and Release Agreement
This waiver and release is entered into between the undersigned and Triangle Adventure Boot Camp, its instructors, officers,
affiliates, and executors.

The purpose of the Adventure Boot Camp Program offered by Jennifer Shevach is to provide fitness instruction and coaching
for various levels of athletes/individuals.

The undersigned hereby agrees to each of the following:
1.        Acknowledges that the instructor is not a physician and is not trained in any way to provide medical diagnosis or any
other type of medical advice.
2.        Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Triangle
Adventure Boot Camp does not guarantee neither good nor bad will occur, nor guarantees the training advice given by
Triangle Adventure Boot Camp or its instructors 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, 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 and 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 Triangle Adventure Boot Camp, its instructors, officers, affiliates, and executors 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 no representatives of Triangle Adventure
Boot Camp nor anyone else has 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.

Write your full name in the box below to agree to the above terms.
Performance Pledge
In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have
established the following policies to which you will need to adhere. Please check each one.
I agree that I will not consume alcohol during the month of Boot Camp.
I agree not to use foul language during Boot Camp.
I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot
Camp.
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.
I will arrive at camp ON TIME.
Any violation of the above statements will result in twenty push-ups per occurrence.
Multimedia Release
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.
Refund Policy
I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp
if, for reasons beyond my control, I am not able to complete the one I originally joined. Camp fees cannot be used
towards any other products or services provided by Triangle Adventure Boot Camp.