Deer Park Adventure Boot Camp, Clear Lake Boot Camp, BayArea

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STEP 1 - CONTACT INFORMATION

First Name:	Required.
Last Name:	Required.
Address:	Required.
City:	Required.
State:	Required.Please enter the two letter abbreviation.
Zip:	Required.Please enter your 5 digit zip.
Profession:
Date of Birth:	Required.Please use mm/dd/yyyy.
Home Phone:	Please use the format: (xxx) xxx-xxxx.
Mobile Phone:	Please use the format: (xxx) xxx-xxxx.
Work Phone:	Please use the format: (xxx) xxx-xxxx.
Email Address:	Required.Invalid email address format.

4 WEEK PROGRAM
$299 - 5 Days a week
$249 - 4 Days a week
$199 - 3 Days a week

For best results, we
highly recommend the 5
day program.

Click here if you have already registered for camp and only need to make payment.

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STEP 2 - BOOT CAMP INFO

Boot Camp Date:	Please choose one. Please choose one.
Boot Camp Location:	Please choose one. Please choose one.
Frequency:	Please choose one. Please choose one.
This is my first camp:	Yes No
The last camp I attended was:	(if applicable)
The last location of my last camp:	(if applicable)
I rate my current fitness level:
I found out about your camp:	Please select one. Please select an item.
My main goal is to:
T-Shirt Size (for free shirt)	Please select a size. Please select a size.

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STEP 3 - MEDICAL HISTORY

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
List Medications:
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
List Medications:
3. Do you have a seizure disorder (epilepsy)?
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)?
7. Do you have or have you ever had the following diseases?
Heart Disease:
Lung Disease:
Kidney Disease:
Liver Disease:
8. Do you have asthma?

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STEP 4 - MEDICAL HISTORY (continued)

9. Have you ever had a severe neck injury?
If yes, please describe:
10. Have you ever been knocked out?
If yes, please 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, please describe:
13. Have you ever injured your back?
If yes, please describe:
14. Do you have back pain?
15. Do you have other physical conditions which cause pain?
If yes, please describe:
16. Detail any surgeries:
17. Are you training for a specific event? Describe:

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STEP 5 - TERMS

	I agree that I will not consume alcohol during the boot camp. Any violation will result in twenty push-ups per occurrence.
	I agree to not use foul language during boot camp. Any violation will result in twenty push-ups per occurrence.
	I agree to not eat or say the words "Hush Puppies, Krispy Kreme donuts, frappucinos, french-fries, pizza, ice cream, Slurpees, chocolate bars, chips, pies, pastries, Ho-Ho's, Ding Dongs, or cupcakes" 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 a NO REFUND POLICY, but I can receive a credit (for unused portion of camp) towards a future camp if I'm not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services provided by Bay Area Adventure Boot Camp.
	I will remember to set my alarm and be at camp on time.
	I will bring a positive attitude, and expect to have fun!
	I have read and agree to the Release Waiver. [Click to read]

BAY AREA BOOT CAMP REGISTRATION

STEP 1 - CONTACT INFORMATION

First Name:

Last Name:

Address:

City:

State:

Zip:

Profession:

Date of Birth:

Home Phone:

Mobile Phone:

Work Phone:

Email Address:

STEP 2 - BOOT CAMP INFO

Boot Camp Date:

Boot Camp Location:

Frequency:

This is my first camp:

The last camp I attended was:

The last location of my last camp:

I rate my current fitness level:

I found out about your camp:

My main goal is to:

T-Shirt Size (for free shirt)

STEP 3 - MEDICAL HISTORY

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?

List Medications:

2. Do you take any prescribed medication on a permanent or semi-permanent basis?

List Medications:

3. Do you have a seizure disorder (epilepsy)?

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)?

7. Do you have or have you ever had the following diseases?

Heart Disease:

Lung Disease:

Kidney Disease:

Liver Disease:

8. Do you have asthma?

STEP 4 - MEDICAL HISTORY (continued)

9. Have you ever had a severe neck injury?

If yes, please describe:

10. Have you ever been knocked out?

If yes, please 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, please describe:

13. Have you ever injured your back?

If yes, please describe:

14. Do you have back pain?

15. Do you have other physical conditions which cause pain?

If yes, please describe:

16. Detail any surgeries:

17. Are you training for a specific event? Describe:

STEP 5 - TERMS

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