SA Adventure Boot Camp for Women Only



You now have two options: You may print this form and mail it; or you can register by clicking the submit button.

If you chose to print, follow these instructions:

  1. Fill in your information, then click the print button of your browser.

  2. Mail to: SA Adventure Boot Camp, 5804 Babcock Rd. #115, San Antonio, TX 78240-2134

  3. You will be notified to schedule your pre-camp evaluation.

Privacy Act: We will NOT share any of your information with anyone.

YES, I’m ready for the Adventure Boot Camp. Sign me up!

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Date of Birth
Cell Phone
Work Phone
Home Phone
FAX
E-mail

Medical History

Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?      Do you wear glasses or contact lenses?
Do you take any prescribed medication on a permanent or semi-permanent basis?              Have you had a broken bone or fracture in the past 2 years? Explain

Do you have a seizure disorder?             

Have you ever injured your back?           
Do you have diabetes (Adult) Type 2 or (Juvenile) Type 1?            List Medications Do you have back pain? 

r with vigorous exercise or heavy lifting
Have you ever been found to be anemic (low blood count)?      Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:
Do you have High Blood Pressure (hypertension)? Do you have other physical conditions which cause pain? Describe:
Do you have or have you ever had the following diseases?   Kidney DiseaseLiver Disease Detail any surgical procedures
Do you have Asthma ?       List Medications: What are your goals for the next three months? Describe:
Have you ever had a severe neck injury? Describe: Have you had your body fat tested?      If yes, what percentage is it? %
Have you ever lost consciousness (been knocked out)?     Describe: Are you training for a specific event?   Describe:

NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!

RELEASE

This release is entered into between the undersigned and SA Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the public and private facilities used, the City of San Antonio, and the County of Bexar. The purpose of SA 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 SA Adventure Boot Camp 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, and that SA Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by SA Adventure Boot Camp 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/activities including the elements of a natural environment, 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 SA Adventure Boot Camp 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 SA Adventure Boot Camp. 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.

Please read and check each of the following statements:

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 eat or say the words Try, Twinkie, Donuts, Ho-Ho's, Ding Dong, Cup Cake, Tacos, or Enchiladas 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 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 no refund policy. Camp fees cannot be used towards any other products or services provided by SA Adventure Boot Camp.
 I will remember to set my alarm and be at camp ON TIME.

How did you hear about us? Please check all that apply:

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Internet Friend    
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Select the camp for which you are registering:

Choose one of the following options:

SA Adventure Boot Camp - January 9, 2012 - 5 Week Special - 3 times a week for $225
SA Adventure Boot Camp - 5 times a week for $299
SA Adventure Boot Camp - 3 times a week for $180
Nutritional Program - $400
Nutritional Program Follow Up- $200