Create Camper Account 1 Contact Information2 Medical History3 Terms Name* First Last Email* Enter Email Confirm Email Your email will be your login User NameUser Name*Password* Enter Password Confirm Password Strength indicator Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Mobile Phone*Home PhoneProfessionEmergency Contact* First Last Emergency Contact Phone*How Did You Hear About Us?*Friend / ReferralGoogleFacebookYahoo/BingGrouponYelpCraigslistFlyerExpoOther Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?*YesNoList Medications*Do you take any prescribed medication on a permanent or semi-permanent basis?*YesNoList Medications*Do you have a seizure disorder (epilepsy)?*YesNoDo you have diabetes (Adult or Juvenile)?*YesNoHave you ever been found to be anemic (low blood count)?*YesNoDo you have High Blood Pressure (hypertension)?*YesNoDo you have asthma?*YesNoDo you have or have you ever had the following diseases?*Select all that apply Heart Disease Lung Disease KidneyDisease Liver Disease None Have you ever had a severe neck injury?*YesNoPlease describe*Have you ever been knocked out?*YesNoPlease describe*Do you wear glasses or contact lenses?*YesNoHave you had a broken bone or fracture in the past 2 years?*YesNoPlease describe*Have you ever injured your back?*YesNoPlease describe*Do you have back pain?*YesNoDo you have other physical conditions which cause pain?*YesNoPlease describe*Detail any major surgeriesAre you training for a specific event?*YesNoPlease describe* Terms and Conditions*Check that you agree and have read the terms and conditions I agree that I will not consume alcohol during the month of Boot Camp. But if I choose to, I understand that doing so can affect my results in a negative manner. I agree to not use foul language during boot camp (out of respect for other campers). I agree not to eat foods that are fried, made with lots of sugar, have saturated fat or anything else not deemed healthy by the boot camp instructor during the course of Boot Camp. But if I choose to, I understand that doing so can affect my results in a negative manner. I agree to show up for Boot Camp every day. But if I do not, I understand that doing so can affect my results. 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 that if I am unable to attend camp due to circumstances out of my control, I can get a refund if I notify camp directors prior to my session start date, minus a $50.00 cancellation fee. If I notifiy camp directors after my session begins, I can only receive a credit towards another boot camp. The credit must be used within 45 days of original camp start date. Credit cannot be used toward private fitness training, but can be applied to small group training. There is no cash refund. This is not negotiable. I will remember to set my alarm and be at camp on time. I will bring a positive attitude, and expect to have fun! Fitness Release Waiver*Check that you have read and acknowledge the Fitness Release Waiver. Click to Read I have read and agree to the Release Waiver. This iframe contains the logic required to handle AJAX powered Gravity Forms.