Wufoo

Contact and Enrollment Form

Please complete all fields before submitting.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone * ### - ### - ####
Mobile Phone * ### - ### - ####
Private Physician
Phone ### - ### - ####
Emergency Contact *
Phone * ### - ### - ####
Date of Birth * MM / DD / YYYY
Weight *
Height *
Gender *
How did you hear about us? *
When would you like to start? * MM / DD / YYYY
What is a good time for you? *
5.30 AM - Morning 9.30 AM - Morning 6.30 PM - Evening
How often? *
2 times per week 3 times per week unlimited
Fitness Level? *
I would rate my fitness level as a Beginner (has worked out 10 times or less in the last 12 month with resistance/cardio training). I would rate my fitness level as that of Intermediate (works out 2-3 times per week with resistance/cardio training). I would rate my fitness level as that of Advanced (works out 3-5 times per week with resistance/cardio training).
How would you describe your eating habits? *
I eat to much I do not eat enough I really don't know much about eating - Help me please... I love sweats I love salt
How is your fluid intake? *
I drink lots of water I drink lots of soda I really don't know much about fluids - Help me please... I drink alcohol daily I do not drink a lot at all
Do you have a before picture? Send it here...

If you want to improve your body show us where you are now, when it comes to your appearance, and we will provide you with a free body evaluation, monthly measurements and weighings. This will guide you through a amazing transformation.
Health Assessment
Date of last full physical MM / DD / YYYY
Have you ever had any form of heart disease? *
Have you ever experienced shortness of breath or chest pains? *
Do you have or do any of the following pertain to your health? If yes, please explain.
High blood pressure? Cigarette Smoking? Third choice Diabetes? Family history of heart disease? Asthma? Are you currently taking medication? Seizure Disorder?
Explaination:
Do you have problems in the following areas?
Knees Lower Back Neck/Shoulder Hip/Pelvis Any Other
Pricing & Plans

We ask for a minimum 4 week commitment to guarantee our success with your short term goal.
Choose your package first: *
Bronze Ticket / 12 sessions / $180 Silver Ticket / 20 sessions / $240 Golden Ticket / unlimited / $290 10 Session Card / $200 anytime Buddy Rate / Contact us first per email

Please feel free to go to our Rates & Pricing page to find out about details
Boot Camp T-Shirts

Please select your Boot Camp Fitness T-Shirt Size:
(The T-shirt is for NEW bootcampers only. If you are a returning vet and want to order a Boot Camp T-shirt, then select a size and - $10 will be added to your registration fee.)
Size
Do Not Fill This Out

Wufoo

Contact and Enrollment Form

Health Assessment

Pricing & Plans

Boot Camp T-Shirts