Women and Men's Adventure Fitness Boot Camp in Ahwatukee, bootcamp for women and men, adventure boot camp, womens and men fitness program, womens and men weight loss, exercise camp, womens and men camp, exercise, workout programs, outdoor exercise

Ahwatukee Camper Registration Form

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Fields with * are required fields.

Full Name: *
E-mail Address: *
Address: *
City: *
Zip: *
Date of Birth: *
Your Home Phone: *
Your Work Phone: *
Emergency Contact Name: *
Emergency Contact Phone: *
Fax Number:
Your Job Description:
Program Type: * 5 days/week - $299
4 days/week - $240
3 days/week - $199
Holiday Camp (Dec 1-19 ONLY) - $225
Camp Start Date and Time: *
Is this your first camp? * Yes
No
If you answered No above, when was the last camp you attended?
How did you hear about Ahwatukee Adventure Boot Camp?
If you answered Other above, please specify how you heard about us.
I rate my current fitness level as a: *
What is your main goal for this boot camp?
Are you training for anything specific? If yes, please specify.
Comments/Notes: Please enter any notes re: camp for your instructor here
Form of payment (your spot is NOT guaranteed until payment is received): * Visa
Mastercard
American Express
Check
Cash
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)? If yes, please specify.
2. Do you take any prescribed medication on a permanent or semi-permanent basis? If yes, please specify.
3. Do you have a seizure disorder? Yes
No
4. Do you have diabetes? If yes, please list medications.
5. Have you ever been found to be anemic (low blood count)? Yes
No
6. Do you have High Blood Pressure (hypertension)? If yes, please list medications.
7. Do you have or have you ever had any of the following diseases: Heart Disease, Lung Disease, Liver Disease, Kidney Disease. If yes to any, please specify.
8. Do you have asthma? List medications, if applicable.
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 lens? Yes
No
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? Never
Seldom
Occasionally
Frequently with vigorous exercise or heavy lifting
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? If yes, please describe.
16. Do you have other physical conditions that cause pain? If yes, please describe.
17. Detail any surgical procedures:
By clicking this checkbox, I signify that I have read and agree with all the above text. *

* Required

For More Information, Contact us at (623) 640-2680 or e-mail Dawn@AhwatukeeBootCamp.com