Personal Information

 

Date of Birth *

Self Assessment & Additional Information

I rate my current fitness level as a (1-10), ten being high:

I was referred by: (Full Name, Email or Website)

Is this your first Camp? If No, When was the last session you attended:

What is your main goal or reason for joining Boot Camp:

Name of Emergency Contact & Phone Number:

Simple Medical History Questionnaire

Are you currently taking any medications?

Do you have any medical conditions that may preclude you from participating in rigorous physical activities?

Do you suffer from any diseases such as Diabetes, Liver, Lung, Heart or Kidney disease?

Do you have any physical conditions or previous injuries that may preclude you from participating in rigorous physical activities?

Release and Terms of Agreement

*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 WorkoutLA, its officers, subsidiaries, affiliates, and executors in addition to the City of Los Angeles. The purpose of WorkoutLA is to provide fitness instruction, coaching, and nutritional advice 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 WorkoutLA staff 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 WorkoutLA does not guarantee either good or bad results will occur nor does it guarantee training advice given by the staff.

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 their training, or otherwise, that the undersigned should contact a physician immediately.

4. Acknowledges that personal training, boot camps, aerobic classes, martial arts, kick boxing, running, weight training, obstacle courses, and any other related activities are an extreme test of one's mental and physical limits and carry with them potential for damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of 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 WorkoutLA, including WorkoutLA staff, for the undersigned participating in said activities and/or training for said activities.

The Undersigned agrees that this is the full agreement between the parties, that neither WorkoutLA 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.

The Undersigned agrees to confidentiality with respect to WorkoutLA and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of WorkoutLA. The undersigned agrees to a non-compete within a 50 mile radius for a period of 5 years from date of participation.

I agree to all Terms and Conditions listed above.

By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent

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Use of this Service Requirements

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  • You consent to receive electronically any records, notices, agreements or disclosures made to you by our client, the referring service, during the course of your relationship with that company, subject to revocation per terms above.

Electronic Signature         Disclosure & Consent