[swiftsign swift_form_id=”1799″]
Personal Information
[swift_name name=”extra_name_1516681378467″ size=”long”] [swift_address name=”Address” value=”” required size=”long”]
Date of Birth [swift_date_dropdown name=”Date of Birth” class=”Date of Birth” required] [swift_phone name=”Phone” placeholder=”Phone” required size=”medium”]
[swift_email ] [swift_textbox name=”Profession” placeholder=”Profession” size=”long”]
Self Assessment & Additional Information
I rate my current fitness level as a (1-10), ten being high: [swift_dropdown name=”Rate my current fitness” option_values=”1-low, 2, 3, 4, 5, 6, 7, 8, 9, 10-high “]
I was referred by: (Full Name, Email or Website) [swift_textbox name=”Referred By” required size=”long”]
Is this your first Camp? When was the last session you attended: [swift_dropdown name=”Dropdown” option_values=”No, Yes” selected_option=”No” required] [swift_textbox name=”First Camp” required size=”medium”]
What is your main goal or reason for joining Boot Camp: [swift_textbox name=”Main Goal” required size=”long”]
Name of Emergency Contact & Phone Number: [swift_textbox name=”Emergency Contact” placeholder=”Emergency Contact” required size=”medium”][swift_textbox name=”Emergency Phone” placeholder=”Emergency Phone” required size=”medium”]
Simple Medical History Questionnaire
Are you currently taking any medications? [swift_dropdown name=”YN Dropdown” option_values=”No, Yes” selected_option=”No” required] [swift_textbox name=”Medications” size=”medium”]
Do you have any medical conditions that may preclude you from participating in rigorous physical activities? [swift_dropdown name=”YN Dropdown” option_values=”No, Yes” selected_option=”No” required] [swift_textbox name=”Medications” size=”medium”]
Do you suffer from any diseases such as Diabetes, Liver, Lung, Heart or Kidney disease? [swift_dropdown name=”YN Dropdown” option_values=”No, Yes” selected_option=”No” required] [swift_textbox name=”Medications” size=”medium”]
Do you have any physical conditions or previous injuries that may preclude you from participating in rigorous physical activities?
[swift_dropdown name=”YN Dropdown” option_values=”No, Yes” selected_option=”No” required] [swift_textbox name=”Medications” size=”medium”]
Release and Terms of Agreement
*NOTICE*: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!
Waiver of Liability and Terms of Agreement
By participating in the outdoor bootcamp offered by WorkoutLA, the undersigned acknowledges and agrees to the following terms:
1. Acknowledgment of Risks: The undersigned acknowledges that participation in activities such as personal training, boot camps, aerobic classes, martial arts, kickboxing, running, weight training, obstacle courses, boxing and any other related activities involves risks of serious injury, disability, or death.
The undersigned assumes these risks, including the risks associated with natural environments, and is solely responsible for any and all medical treatment necessary as a result of their participation.
2. Release and Waiver of Liability: The undersigned expressly waives, releases, and discharges WorkoutLA, its officers, subsidiaries, affiliates, and executors, in addition to the City of Los Angeles and its staff from any and all liability for any injury, disability, or death resulting from participation in activities or training provided by WorkoutLA.
3. No Guarantee of Results: The undersigned acknowledges that while coaching and training are tools for self-improvement, WorkoutLA does not guarantee any specific results, either positive or negative.
4. Medical Advice: The undersigned acknowledges that WorkoutLA staff are not physicians and are not trained to provide medical diagnosis, treatment, or advice. If the undersigned person feels any pain, tiredness, or discomfort, they should seek medical attention immediately.
5. Confidentiality and Non-Compete: The undersigned agrees to maintain confidentiality regarding WorkoutLA and all services provided by the organization. The undersigned also agrees to a non-compete agreement within a 50-mile radius for a period of 5 years from the date of participation.
By signing this waiver, the undersigned confirms that they have read and fully understand the terms and conditions outlined in this agreement, that they have sought medical advice if necessary, and that they enter into this agreement voluntarily and without coercion.
[swift_agree] I agree to all Terms and Conditions listed above.
[swiftsignature size=”medium”]
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[/swiftsign]