WIRED FITNESS BOOTCAMP REGISTRATION
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NAME *
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ADDRESS
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PHONE (MOBILE) *
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EMAIL ADDRESS*
ADDING YOUR EMAIL ADDRESS HERE AUTOMATICALLY SIGNS YOU UP FOR OUR NEWSLETTER, INFORMATION AND EVENT EMAILS. WE MUST BE ABLE TO COMMUNICATE WITH YOUR DURING YOUR TERM. PLEASE ADVISE TO BE REMOVED AFTER YOUR TERM HAS EXPIRED. THANKS |
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HOW DID YOU HEAR ABOUT WIRED FITNESS? *
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CLIENT REFERRAL
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BOOTCAMP LOCATION
PLEASE PICK YOUR INITIAL PARK AND TIME SLOT FOR YOUR FIRST CLASS. YOU CAN REMAIN IN THAT LOCATION OR MOVE AROUND BETWEEN OTHER LOCATIONS AFTER YOUR INITIAL
CLASS. TO SEE MAP AND LOCATION PLEASE REFER BACK TO THE BOOTCAMP SCHEDULE PAGE ON THE HOME PAGE.
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PLEASE CHOOSE ONE *
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PLEASE REFER BACK TO THE BOOTCAMP SCHEDULE FOR DAYS AND PARK ADDRESSES.
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ANTICIPATED START DATE FOR YOUR FIRST CLASS *
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DD
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YYYY
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HOW MANY CLASS DAYS PER WEEK DO YOU WISH TO ATTEND? *
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SPECIAL SCHEDULING NOTES
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ACCESSORIES
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WOULD YOU LIKE TO PURCHASE YOUR WORKOUT GLOVES OR WORKOUT MAT FROM US?
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PLEASE INCLUDE YOUR SIZE AND ANY SPECIAL NOTES
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PACKAGE TYPE
PLEASE CHOOSE WHICH BOOTCAMP PACKAGE YOU ARE INTERESTED IN.
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PACKAGE OPTIONS *
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DID YOU PURCHASE A VOUCHER FROM A DAILY DEALSITE? SELECT ONE
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NUMBER OF VOUCHERS PURCHASED
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VOUCHER | CERTIFICATE NUMBER(S)
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PERSONAL | HEALTH INFORMATION
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AGE *
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WEIGHT *
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HEIGHT *
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SEX *
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FITNESS GOALS (WHAT DO YOU WANT TO ACCOMPLISH BY TAKING THESE CLASSES?)...TIMELINE, LBS LOST, ETC.. *
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HAS YOUR DOCTOR EVER SAID THAT YOU HAVE A HEART CONDITION? *
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HAS YOUR DOCTOR EVER TOLD YOU THAT YOUR BLOOD PRESSURE WAS TOO HIGH? *
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DO YOU EXPERIENCE LOSS OF BALANCE DUE TO DIZZINESS OR DO YOU EVER LOSE CONSCIOUSNESS? *
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DO YOU HAVE A BONE OR JOINT PROBLEM THAT IS AGGRAVATED BY PHYSICAL ACTIVITY? *
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DO YOU HAVE HIGH CHOLESTEROL? *
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ARE YOU OVER 65 YEARS OF AGE AND NOT ACCUSTOMED TO VIGOROUS EXERCISE? *
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FEMALES: ARE YOU PREGNANT? *
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DO YOU KNOW OF ANY OTHER REASON THAT WOULD NOT ALLOW YOU TO PARTICIPATE IN A PHYSICAL FITNESS PROGRAM (IF YES, EXPLAIN BELOW)?
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EXPLAIN ALL DETAILS HERE IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS
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POLICIES AND PROCEDURES FORM
ANY QUESTIONS REGARDING ATTENDANCE, SCHEDULING, TARDINESS, BILLING (CCs, CANCELLATIONS, DISCOUNT TERMS, FEES), ETC.
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I UNDERSTAND THIS FORM MUST BE SUBMITTED FOLLOWING THE COMPLETION AND SUBMISSION OF THE REGISTRATION FORM TO PARTICIPATE IN ANY WIRED FITNESS
PROGRAM (LINK IS UNDER 'GET STARTED' ON THE MENU) *
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ELECTRONIC LIABILITY WAIVER
I, (FULL NAME | DATE BELOW) have read the following waiver, understand, and agree to its contents.
THE FOLLOWING IS A WAIVER. READ IT BEFORE SIGNING. BY AFFIXING MY SIGNATURE TO THIS DOCUMENT, I ATTEST, CONTRACT, UNDERSTAND AND AGREE THAT I AM TO BE LEGALLY BOUND BY ITS CONTENTS.
I hereby stipulate and agree: That I realize the risks of cardiovascular exercise, weight lifting, weight training and/or body building, and I am fully aware of the possibility of
malfunctions of equipment.
I, therefore fully understand and I am mindful of the serious consequences which might result due to my involvement in cardiovascular exercise, weight lifting, weight training and/or body
building while training with Wired Fitness, and based on that understanding, as set forth in this paragraph, I voluntarily assume any and all risk of loss, damage or injury of any kind
whatsoever from my use of any and all of the equipment of Wired Fitness, and further and with full knowledge of the consequences (i.e. that I am waiving my right to sue) expressly waive the
part of Wired Fitness, and the operator of Wired Fitness, and from my use of Wired Fitness' equipment and/or facilities. That I am physically sound and have medical approval to proceed with
a normal routine of exercise. That all exercises shall be undertaken by me at my sole risk. That I am in good health and have no physical conditions that would be aggravated by my
involvement in cardiovascular exercise, weight lifting, weight training and/or body building, nor do I have any physical limitations that would preclude said involvement. I also release
Wired Fitness, its contractors (the personal trainers), and the Cities of Chula Vista, San Diego, and Encinitas from liability for their negligence, defective equipment, injuries from
dangerous conditions of property, etc.
HAVING READ THE ABOVE TERMS AND INTENDING TO BE LEGALLY BOUND HEREBY AND UNDERSTANDING THIS DOCUMENT TO BE A COMPLETE WAIVER AND DISCLAIMER IN FAVOR OF WIRED FITNESS OF ANY AND ALL
LIABILITY, I HEREBY AFFIX MY SIGNATURE HERETO.
Additional Policies: You will be asked to read, know, and sign a 'Policies and Procedures' web-based document at the time of enrollment. These policies will be enforced
throughout your term and should be followed to ensure focus is maintained on your goals. Emergencies, freezes and special consideration will be handled at the trainer's discretion. Before
and after pictures may be requested. Photographers may be present during class time photographing for our 'Photo Gallery' and for advertising and media purposes. Please let the trainer know
if you have any concerns.
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FULL NAME (IF UNDER 18, PARENT OR GUARDIAN MUST COMPLETE THIS SECTION) *
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DATE SIGNED *
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YYYY
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