FIT IN, INC.
Outdoor Fitness Boot Camp Registration


$215.00 (4 WEEK P.M. CAMP)
If paying by check/money order, please make payable to:
Fit In, Inc.
1323 S. 47th Street, Suite A
Philadelphia, Pa 19143
info@fitininc.com
Phone: 215.222.0600 Ext. 2
 

* Required fields
Name *
E-mail Address *
Which of the following sessions are you planning to join? *	MON,WED,FRI 6:00-7:00P.M. (Evenings) $215
Credit Card Type *	none Visa Mastercard American Express Gift Card
Card Number *
Card Expiration Date: *
Address, City, State, & Zip *
My main goal is *
Phone Number *
Cell Number (optional)
Date of Birth
Profession
Emergency Contact Name & Number *
I rate my current fitness level as a (1-10), ten being the highest *
I was referred by
Are you allergic to any medication? (Aspirin, penicillin, sulfa, etc.) *	Yes No
List Medications
Do you take any prescribed medication on a permanent or semi-permanent basis? *	Yes No
List Medications
Do you have a seizure disorder? (Epilepsy) *	Yes No
List Medications
Do you have diabetes? (Adult or Juvenile) *	Yes No
Do you have high blood pressure? (Hypertension) *	Yes No
Do you have or have you ever had the following diseases? (Heart,Lung,Kidney, & Liver disease) *
Do you have asthma? *	Yes No
List Medications
Have you had a broken bone or fracture in the past 2 years? *	Yes No
Describe
Have you ever injured your back? or Have Back pain? *	Yes No
Describe
Have you had knee pain in the past 2 years that has disable you for longer than a week? *	Yes No
Describe
Do you have other physical conditions, which cause pain? *	Yes No
Describe
Detail any surgical procedures *

I have read and agree to the Privacy Policy *

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RELEASE

This release is entered into between the undersigned and Fit In, Inc.; it’s officers, and executors. The purpose of Fit In, Inc Outdoor Fitness Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals.

The undersigned hereby acknowledge that the explained to me and/or agree to following:

1. Acknowledges that Angie Womack is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other types of medical advice.

2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Fit In, Inc. does not guarantee neither good nor bad will occur nor guarantees training advice given by Angie Womack including Fit In, Inc. Outdoor Fitness 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, calisthenics, kick boxing, running, 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 regular medical physician they can contact regarding any medical problems that they night develop. The undersigned expressly waive, release, discharge and agree not use to sue form any liability of death, disability, personal injury, or action of any kind Fit In, Inc. 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 Fit In, Inc. including Angie Womack 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 force or coercion.

Customer client agrees to confidentiality with respect to Fit In, Inc. and all services provided by same. The undersigned agrees to refrain from directly or indirectly, any all aspects of Fit In’s Outdoor Fitness Boot Camp. The undersigned agrees to non-compete within a 50-mile radius of Philadelphia County, Pennsylvania for period of 5 years from date of participation.

Checkmark the following:
> I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence.
> I agree not to eat or say the words Twinkie, Donuts, Ho-Ho’s, or Cup Cake during the course of Boot Camp. Any violations 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 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 nay promotional purposes unless I give written authorization.
> I understand there is no refund policy. Credit will be given for future camp if unable to complete camp due to medical records.
> I will remember to set my alarm and be at camp on time.
> I understand that diet and nutrition will affect my fitness goals and performance during boot camp.
> I will bring a positive attitude, and expect to have fun!