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Which style of training would you like to join?
MFP Enrollment | Official Registration Form
Indoor Boot Camp, Personal Training or Online Coaching
____________________________
Glad you're joining Mannys Fitness Program where your results are GUARANTEED!
{{{GEAR REQUIREMENT | GEAR REQUIREMENT | GEAR REQUIREMENT}}}
Please remember to have proper workout gear, proper running shoes, gloves (optional), yoga mat (optional), sweat towel and water to drink. We look forward to seeing you part of the program either personally or online.
PLEASE READ | PLEASE READ | PLEASE READ | PLEASE READ
*Full enrollment payment needs to be made before starting the program in order to officially reserve your spot. Be sure to check your "Welcome Email" after submitting your registration (check spam folder if necessary). Please contact us if otherwise.
*Please enter all of the required fields.
Name
*
First
Last
Are you 18+ years of age?
*
Yes
No
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Home Phone Number
(or same as cell phone)
*
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Cell Phone Number
(text friendly)
*
###
-
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Email
*
*A "Welcome" email regarding your spot reservation and all other additional information will be emailed to this email address. Please be sure it's a correct and working email address.
Other Notice.
Please check your junk or spam folder if the confirmation "Welcome" email doesn’t show up in your inbox. If nothing is received please call and contact us directly.
Emergency Contact Name and Phone Number
*
How did you hear about us?
*
Did someone refer you to Mannys Fitness Program?
*
No
Yes (If yes please provide the name below)
Who referred you?
Do you have a friend or family member that would like to join?
*
No
Yes (If yes please provide the name below)
A $20 Gift Certificate Applies per new join. No Limit.
*Only applies to New Joins without a promotional discount.
Name of person referring:
Email
Phone Number
###
-
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-
####
Do you have a discount voucher or a Donation Gift Certificate?
*
Yes
No
If yes, please add your Certificate Title.
INDOOR BOOT CAMP - PERSONAL TRAINING - ONLINE COACHING
4 Weeks | 3 Days Per Week | 12 Training Days | 1 Hour Sessions
Indoor Boot Camp - Group Training
Lompoc Schedule #1
6:30 PM
Mon, Wed & Fri
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Indoor Boot Camp - Group Training
Lompoc Schedule #2
5:30 PM
Mon, Wed & Fri
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
**Personal Training - 1 on 1
Lompoc Schedule #3
6:15 AM
Mon, Wed & Fri
*45 Min | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Indoor Boot Camp - Group Training
Lompoc Schedule #4
5:00 AM
Mon, Wed & Fri
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Indoor Boot Camp - Group Training
Lompoc Schedule #5
5:00 AM
Tue, Thur & Sat (6:30am)
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
**Personal Training - 1 on 1
Lompoc Schedule #6
6:15 AM
Tues, Thur & Sat (5:30am)
*45 Min | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Indoor Boot Camp - Group Training
Lompoc Schedule #7
5:30 PM
Tue, Thur & Sat (7:30am)
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Indoor Boot Camp - Group Training
Lompoc Schedule #8
6:30 PM
Tue, Thur & Sat (6:30am)
*1 Hr | 3 Days
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
ONLINE COACHING
Workout Videos/Coaching | 1 Hour Sessions
Online Coaching
N/A
Sign Me Up | Current 4 Week Training
Sign Me Up | Next 4 Week Training
Bi-Weekly one-on-one ZOOM sessions (15 Min Sessions)
3 Workout Videos Per Week
Bi-Weekly Slack Q and A and progress update (Goal Status)
Calorie and Macronutrient monitoring (Custom Meal Plan)
Form and Technique feedback via video (Exercise Modifications)
Access to our private Active Members Only group on Slack (Members only group)
Customized program design with monitoring at designated follow-up time (Goal Setting)
--------------------------------
OTHER OPTIONS AVAILABLE
Please fill out the information accurately.
How would you rate your current fitness level (10 being best and 1 being worst):
*
1
2
3
4
5
6
7
8
9
10
What is your main fitness goal?
*
Are you training for an event such as a future career, race, reunion, wedding etc?:
Yes
No
If so, what is it?
When is it?
MM
/
DD
/
YYYY
What is your current Profession?
*
Date of Birth
*
MM
/
DD
/
YYYY
Fitness Background Comments
NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program.
Are you allergic to any medications?
*
Yes
No
If yes, please describe
Do you take any prescribed medication on a permanent or semi-permanent basis?
*
Yes
No
If yes, please describe
Do you wear glasses or contact lenses?:
*
Yes
No
Do you have or have you ever had the following:
*
Diabetes
Asthma
Anemia
High blood pressure (hypertension)
Seizure disorder (epilepsy)
Heart disease
Lung disease
Kidney disease
Liver disease
None
How many hours do you regularly sleep at night? #
*
Height? ft' in"
*
Current Weight? lbs
*
Have you ever been knocked out?
*
Yes
No
If yes, please describe
Have you had a broken bone or fracture in the past 2 years?
*
Yes
No
If yes, please describe
Have you ever had a severe neck injury?
*
Yes
No
If yes, please describe
Have you ever injured your back?
*
Yes
No
If yes, please describe
Do you have back pain?:
*
Never
Occasionally
Frequently w/ vigorous exercise or heavy lifting
Have you had knee pain in the past 2 years that has disabled you for longer than a week?
*
Yes
No
If yes, please describe
Do you have other physical conditions which cause pain?
*
Yes
No
If yes, please describe
Detail any surgical procedures:
Do you smoke?
*
Yes
No
If yes, how many per week
Do you drink alcohol?
*
Yes
No
If yes, how many drinks per week
RELEASE
This release is entered into between the undersigned and Mannys Fitness Program. The purpose of Mannys Fitness Program is to provide fitness instruction, motivation and coaching for any individual fitness level.
The undersigned hereby acknowledge that the following was explained to me and/or agree to the following:
1. Acknowledges that Mannys Fitness Program is not a licensed physician and is not trained in any way to provide medical diagnosis, medical treatment or any other type of medical advice, only recommendations.
2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves but that Mannys Fitness Program does not guarantee neither good nor bad will occur nor guarantees the training advice given by Mannys Fitness Program 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, 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 inherent dangers of the natural elements 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 and Mannys Fitness Program 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 Mannys Fitness Program nor 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.
Contract Agreement:
Attendance
*
I agree that if I am taking advantage of MFP, I must attend all training days for which I am registered unless excused in a timely manner.
Contract Agreement:
Photos and Video Consent
*
I understand that photos or video may be taken during the course of my involvement in MFP which may be used for promotional purposes.
Contract Agreement:
Refund Policy
*
I understand there is no refund policy. By signing up for camp I am making a commitment to myself. I am committed to a fit and healthy lifestyle. I understand that MFP will accept no excuses for my failure to fulfill my commitment.
This is a legal electronic contract therefore legal actions are activated upon submission.
ATTENTION!!!!
***BEFORE YOU SUBMIT!!!!
(read carefully)
Be sure you receive our "Welcome to MFP" email after sending registration form.
FAILURE TO DO SO WILL RESULT IN ANY MISCOMMUNICATION.