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

Boot Camp Registration

Lynnwood Adventure Boot Camp
REGISTRATION

You have 2 options:
1. Register Online - Complete the registration below and click "SUBMIT...I am READY to Get Fit!"
2. Complete the registration below, print it, and mail it with payment to the address below.

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 payable to:
Lynnwood Adventure Boot Camp

Correspondence Mailing Address:
4516 188th Street SW
Lynnwood, WA 98037-4637

Burnis@BodyByBurnis.com
Phone: (206) 304-3453

Registration Form
You will be notified to schedule your pre-camp evaluation (if needed for your program).
Personal Information:
Name (First & Last):		Address:
City:		State / Zip Code:	/
Date of Birth:	(mm/dd/yyyy)	Profession:
Home Phone #:		Cell Phone #:
Work Phone #:
Primary E-mail Address: (Home)		Secondary E-mail Address: (Work or Additional Account)

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 are you joining?

View Calendar

5-Days $240 = 3-Week Camps $255 = 4-Week Camps	4-Days $180 = 3-Week Camps $205 = 4-Week Camps	3-Days $135 = 3-Week Camps $160 = 4-Week Camps

AM Camp Monday - Friday 5:30AM - 6:30AM	AM Camp Monday - Friday 5:30AM - 6:30AM You Choose Your 4-Days Each Week To Fit Your Schedule	AM Camps Monday - Friday 5:30AM - 6:30AM You Choose Your 3-Days Each Week To Fit Your Schedule Monday, Wednesday, & Thursday ONLY 9:30AM - 10:30AM Open to All Women Including MWBIS
*Mom's With Babies In Strollers (MWBIS)*
	PM Camp Monday - Thursday 5:15PM - 6:15PM	PM Camps Monday - Thursday 5:15PM - 6:15PM You Choose Your 3-Days Each Week To Fit Your Schedule Monday, Wednesday, & Thursday ONLY 6:20PM - 7:20PM

Form of Payment:

Credit Card Information:
For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time to process your registration. PLEASE verify all credit card numbers are input correctly before sending.
*Credit Card Number (No Spaces):*	Visa Master Card - - -
Expiration Date:	/
Name as Printed on Credit Card:
*CVC Code:	*(Security Code)
*Visa and MasterCard In the signature box on the back of your card you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.

Medical History:
*(If you are a returning camper, you need only complete the items below that have changed.)*
1. Are you allergic to any medications (aspirin, penicillin, sulfa, etc.)?
If you answered YES to question #1, please list medications:
2. Do you take any prescribed medications on a permanent or semi- permanent basis?
If you answered YES to question #2, please list medications:
3. Do you have a seizure disorder (epilepsy)?
4. Do you have diabetes Adult or Juvenile?
If you answered YES to question #4, please list medications:
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
If you answered YES to question #6, please 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?
If you answered YES to question #8, please list medications:
9. Have you ever had a severe neck injury?
If you answered YES to question #9, please describe:
10. Have you ever been knocked out?
If you answered YES to question #10, please describe:
11. Do you wear glasses and/or contact lenses?
12. Have you had a broken bone or fracture in the past 2-years?
If you answered YES to question #12, please describe:
13. Have you ever injured your back?
If you answered YES to question #13, please 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?
If you answered YES to question #15, please describe:
16. Do you have other physical conditions which cause pain?
If you answered YES to question #16, please 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 you answered YES to question #19, when were you tested and what was the percentage?
20. Are you training for a specific event?
If you answered YES to question #20, please explain:

Release:
NOTICE: It is wise to seek your doctors advice before beginning any health, fitness, or nutrition program! This release is entered into between the undersigned and Body by Burnis, LLC, its officers, subsidiaries, affiliates, and executors. The purpose of Lynnwood Adventure Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals. The undersigned hereby acknowledge that the following was explained to me and/or agree to the following:
1. Acknowledges that the instructors are not physicians and are not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.
2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Body By Burnis, LLC does not guarantee neither good nor bad will occur nor guarantees the training advice given by the instructors of Body By Burnis, LLC 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 elements of a natural environment, 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 Body By Burnis, LLC 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 Body By Burnis, LLC including all instructors or 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 without force or coercion. Customer client agrees to confidentiality with respect to Body By Burnis, LLC and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Body By Burnis, LLC. The undersigned agrees to a non-compete within a 50 mile radius of Lynnwood for a period of 5-years from date of participation.
Checkmark the Following:
	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. 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 Lynnwood Adventure Boot Camp.
	I will remember to set my alarm and be at Boot 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.

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) 304-3453 or e-mail Burnis@BodyByBurnis.com