Anthony Church Official Website - Fitness Boot Camp Enlistment Page

Fitness Boot Camp - Anthony Church

ENLISTMENT

All entires marked with an * are required

First Name: *
Last Name: *
Street Address: *
Additional Address:
City: *
State: *
Zip Code: *
E-mail: *
Primary Phone: *
Fax:
Age: *
How did you hear about us? *
Other details/comments.
Current Activity Level: *	Very Active (Exercise 5-7 Days/week) Active (Exercise 3-4 days/week) Moderate (1-2 days/week) Sedentary (Not currently exercising)
Emergency Contact's Name: *
Emergency Contact's Phone Number: *

Current or previous injuries we should know about. Please list and describe thoroughly including the outcome of doctor's visits, surgury, etc. How was injury resolved? Is it still a problem?

Are you currently taking any medications or have any medical issues we should know about. Please list names and dosages.

* By checking this box and clicking the "Submit" button below, I am acknowledging that I have read and understand the Acceptance and Disclaimer/Release Form, which must be printed out, signed, and brought on the first day of camp. I understand that failure to produce this on the first day will result in an inability to participate until this form is received. I may download the form by clicking HERE. * - Anyone without the release form filled out will be required to fill it out on the first day of class before participating.

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