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

Boot Camp Registration Form

Puget Sound Adventure Boot Camp Class
REGISTRATION

You now have 2 options:
A. You can print this form and send it in with payment by mail

B. Register Online
Fill out the online form below to register via internet.
Click on Submit.
If you are sending in a check, please send in prior to the start of camp.
If you are paying via credit card, you will be redirected to PayPal when you hit submit to finish your payment.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

If paying by check, please make check out to:
Puget Sound Adventure Boot Camp
PO Box 4113
Federal Way, WA 98063-4113
clemence@pugetsoundbootcamp.com
Phone: (206) 280-4642

Registration Form
You will be notified to schedule your pre-camp evaluation (if needed for your program).
Personal Information
Name		Address
City		State / ZIP	/
Profession		Country
Date of Birth	(mm/dd/yyyy)	Phone Number
Cell Number		Cell Phone Provider	(For Texting)
Email Address		Fax Number
Have you already received your one time free T-Shirt gift?	Yes No	Shirt Size	SM Med Large X Large 2 XL

Self Assessment & Additional Information
I rate my current fitness level as a (1-10), ten being high.
I was referred by:
How did you hear about us?:
Please specify publication / website / friend or other referral:
This is my first camp:	Yes \| No
If you answered "no", when was the last camp you attended:
My Main goal is:
Name of Emergency Contact & Phone Number	\|

Camp and Payment Information
What camp will you attend?
Choose your camp frequency and cost.
How do you know your supplements are working? Add a Biophotonic Scan $10
Form of payment:
9:15AM Federal Way Steel Lake Park and Annex - 4 or 3 days a week, only options available. 5:30AM Kent Meridian and FW Todd Beamer- 5, 4, 3 Days a week options available. For maximum results, 5 Days a week is recommended for a complete all encompassing exercise program.

Medical History
(If you are a returning camper, only complete the sections that have changed.)
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?
List Medications:
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
List Medications:
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?
List Medications:
9. Have you ever had a severe neck injury? Describe:
10. Have you ever been knocked out? Describe:
11. Do you wear glasses or contact lenses?
12. Have you had a broken bone or fracture in the past 2 years? Describe:
13. Have you ever injured your back? Describe:
14. Do you have back pain?
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:
16. Do you have other physical conditions which cause pain? Describe:
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested?
If yes, what percent is it?
20. Are you training for a specific event? If yes, explain:

Release
NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program! This release is entered into between the undersigned and A/C Adventures Inc., Puget Sound Adventure Boot Camp, its officers, trainers, affiliates, trainers and executors in addition to the City of Federal Way, Kent, Auburn, Federal Way School District, Kent School District, and the county of King. The purpose of A/C Adventures Inc. is to provide fitness instruction and coaching for various levels of athletes/individuals. The undersigned hereby acknowledges that the following was explained to me and/or agree to the following:
1. Acknowledges that the instructor is not a physician and is not trained in any way to provide medical diagnosis or any other type of medical advice.
2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Adventure Boot Camp and A/C Adventures Inc. does not guarantee neither good nor bad will occur, nor guarantees the training advice given by Adventure Boot Camp and A/C Adventures Inc. or its instructors 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 inherent dangers of the natural elements, 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 and A/C Adventures 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 neither representatives of Puget Sound Adventure Boot Camp or A/C ADVENTURES INC. nor anyone else has 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.
NON COMPETE CLAUSE Due to the unique program model and trade secrets of Adventure Boot Camp, customer client agrees to confidentiality with respect to Puget Sound Adventure Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Puget Sound Adventure Boot Camp. The undersigned agrees to a non-compete within a 50 mile radius of Puget Sound Adventure Boot Camp locations for a period of 5 years from date of participation refraining from any business venture or work with a program that competes with the Adventure Boot Camp model. The undersigned also agrees not to solicit outside products or services to fellow campers without written consent from the owner of Puget Sound Adventure Boot Camp, Clemence Lafrades. You hereby agree that A/C Adventures Inc. shall be entitled to enforce the provisions of this Agreement by any legal means.
PERFORMANCE PLEDGE In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have established the following policies to which you will need to adhere. Please read and check each one.
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, Ding Dong, or Cup Cake 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 without compensation. 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, 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 can not be used towards any other products or services provided by A/C Adventures Inc.
	I will remember to set my alarm and be at camp on time.
	I understand that diet and nutrition will effect my fitness goals and performance during boot camp.
	I will bring a positive attitude, and expect to have fun.
	I agree to plan my weekly meals and exercises.
	I agree to check my email daily for any and all updates concerning camp. It is my responsibility to check my email frequently so I can remain up-to-date on information.
	I agree to workout even on the days I am unable to attend camp.
	I will be honest with myself and the instructor at all times.
	I agree to attend the Pre-Camp Orientation and Nutrition Seminar the Saturday morning prior to the first day of camp from 9-12PM. You will be notified of the address. (Pre-camp for camp 10 iis Dec. 1st from 12-3pm)
	I agree to attend the Post Camp Measurement Party the Saturday morning after the last day of camp.

Agreement and Signature

I agree to all Terms and Conditions listed above

Electronic Signature

Date (MM/DD/YYYY)

For More Information, Contact us at 206-280-4642 or e-mail clemence@pugetsoundbootcamp.com