On-Line Registration Form

Ladies Fitness Boot Camp's

"CHANGING LIVES & BUILDING CONFIDENCE, ONE LADY AT A TIME!"

Ladies Fitness

BOOT CAMP Registration Form

Please put your initials next to the questions that ask for your approval!!
(Once you submit, you will be sent to a Secured Payment Page and then to a Confirmation page. Be sure to right down this information)

Registration Information



First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Home Phone:
Cell Phone:
Email:
Emergency Contact - Name/Phone/Relationship:
Rate Physical Condition 1-10 (10 being the best):
Health History - Age, Height, Weight, Injuries, Medications, etc..:

I will show up to FBC prepared and well hydrated, I will be on time, I will have a positive mental attitude, I will not swear (this includes the use of I CAN`T):
I understand that diet and nutrition will greatly effect my fitness goals and performance during FBC. I agree to make every effort to make wise choices.:
I understand that photos and video may be taken during the course of my involvement at FBC, which may be used for promo purposes and I give my expressed written consent for such use.:
I understand there is no refund policy. I will make every effort to keep my commitments to myself, my teammates, and my coach at FBC.:
I agree to show up for Fitness Boot Camp (FBC) every day unless it is an excused absence from my doctor or approved by the FBC coach.:
Class Option Choice: (#1- 3 days per week 4 weeks $200, #2- 2 days per week for 4 weeks $150, #3 - 3 days per week for 12 weeks $500, #4- 2 days per week for 12 weeks $375, #5 - "OPERATION BEACH BODY" $275 X 3, YEAR, Drop in Card- 10 visits $200, Drop in visit- $25, YOGA BC $50, Child FREE)
Discount Code (if you have one):
FOR OPTION #5 ONLY - YOU AGREE TO THE 12 WEEK COMMITMENT AND AGREE TO HAVE YOUR CARD AUTOMATICALLY CHARGED FOR THE REMAINING 2 MONTHS ON THE FIRST OF THE MONTH AUTOMATICALLY REGARDLESS IF YOU CHOOSE TO COME TO CLASS OR NOT. (please initial):
Your Start Date:
What Location & Time where you wanting to attend?:(Phoenix College 5am, North Phoenix 5am, Litchfield 7pm, Glendale 6:30pm, Wickenburg 5:45am or 6pm , Waddell/Surprise 7pm, Yoga 10am, Kellis HS 2:45pm)
Did you want to add in the Nutrition Tool the "3 Phase Diet Deck" to your program for $29.95 one time fee? This tool WILL help you get to your fitness goals 100% faster then NOT having it, is that worth $29.95 to you? :) :
(you can also get the 3 Phase dietDECK at Walgreens located on Indian School and Litchfield Rd for a $10 discount RIGHT NOW)
How did you here about us? (Google Search, Yahoo Search, Craigslist, Flyer, Back of Truck, Referral (please give name), Email Received, Meetup.com, Paper article, Saw a Sign, Backpage.com, Excercisefriends.com, Church, Litchfield Parks & Rec, Myspace, return, Other:)
How were you going to be paying? (Cash, Check, Credit:)(if paying via cash or check, you must put down a $30 deposit via credit card to hold your spot. This will go towards your fee. If this is not an option for you please leave me a comment in the comment box and I will get back with you)
Waiver - By sending this form below, I certify that I am physically able to use all facilities and do hereby agree that this program is not responsible or liable to me for any injury, accident or loss of personal property. I do hereby release this program and its employees from any claim or cause of action which may have occurred as a result of any medical problem known or unknown which I may have knowledge presently or in the future. I verify no promise or guarantees, other than those written in this agreement, was made to me by this program or its employees. I agree to follow Ladies Fitness Boot Camp instructional guidelines and to cooperatively utilize the program with other participants. I understand that I am working out at my own risk and understand the program has No Liability Insurance for any public places the classes are held. I CERTIFY THAT I HAVE READ THIS AGREEMENT AND AGREE TO THE TERMS HEREIN.:

To receive your weekly newsletters from your class, you need to receive it via email. Please make sure to fill in the information on the next page.
Comments:	Enter comments here!

Next step is the Payment Page.....

*** If you are getting an ERROR Message, you might be submitting from a work computer or a high security computer. With our high security attempts and work computers it may not work, so please try from a home computer first and or contact me at ladiesbootcamp@yahoo.com to register a different way.