Manny's Gym & Boot Camp | Registration Form

Name *

First Last

Are you 18+ years of age? *

Yes

No

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone Number
(or same as cell phone) *

### - ### - ####

Cell Phone Number
(text friendly) *

### - ### - ####

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

### - ### - ####

Do you have a discount voucher or a Donation Gift Certificate? *

Yes

No

If yes, please add your Certificate Title.

INDOOR BOOT CAMP - GROUP WORKOUT

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

Indoor Boot Camp - Group Training
Lompoc Schedule #2
5:30 PM
Mon, Wed & Fri
*1 Hr | 3 Days

Indoor Boot Camp - Group Training
Lompoc Schedule #3
5:00 AM
Mon, Wed & Fri
*1 Hr | 3 Days

Indoor Boot Camp - Group Training
Lompoc Schedule #4
6:30 PM
Tue, Thur & Sat (6:30am)
*1 Hr | 3 Days

Indoor Boot Camp - Group Training
Lompoc Schedule #5
5:00 AM
Tue, Thur & Sat (5:30am)
*1 Hr | 3 Days

Please fill out the information accurately.

How would you rate your current fitness level (10 being best and 1 being worst): *

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: *

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.