Sickfit Bootcamp Registration Form
It is required that you fill out this form to participate in my Bootcamps. PLEASE SEE A PHYSICIAN BEFORE STARTING ANY EXERCISE PROGRAM. SICKFITBOOT CAMP ASSUMES THAT IF YOU PARTICIPATE IN THESE BOOTCAMPS THAT YOU ARE MEDICALLY CLEARED TO PARTICIPATE AND WILL NOT PROVIDE ANY RISK FACTORS THAT WILL PUT YOURSELF OR OTHERS IN AN UNSAFE SITUATION. If you have any issues filling out this Registration Form, please email me at and I can send you a Word or PDF version of this form and you can bring it to your first session.
Last Name *
First Name *
Age *
Gender *
What is your birthdate? *
I just need month and day, ie. (XX/XX)
Email *
I am planning to create a blog and a mass email list, so please provide me with the email that you use the most.
Phone Number *
Please write down the number that would be easiest for me to reach you in case I need to cancel a class, etc..
Emergency Contact #1 Name *
Emergency Contact #1 Relation *
Emergency Contact #1 Phone Number *
Emergency Contact #2 Name *
Emergency Contact #2 Relation *
Emergency Contact #2 Phone Number *
Did you download, print and sign the Release of Liability Waiver found on the "Release of Liability" link on my website? You will need to sign one of these at your first Boot Camp Session. *
Failure to sign a Release Form will mean that you can not participate in Sickfit Bootcamp. You can find the Release of Liability form at this link,
Are you a teacher or employee of a school district and/or private school? *
Which school district do you work for?
If a teacher or employee of a specific school, which school do you work for?
Which Bootcamp Package are you planning to pay for? *
Be prepared to bring a current Teacher and/or Staff ID card from your school district.
Do you have ANY medical conditions that I need to be aware of that may prohibit you from performing certain activities (surgeries, knee/back conditions, etc.)? Please list all of them. *
NOTE: If you have any cardiorespiratory or breathing issues (like asthma risks) or any other issues that may result from increased heart rate, please take all the necessary precautions before attending class (inhaler, etc.). It is your responsibility to manage your exercise intensity based on your physical ability. Sickfit Bootcamp is assuming that you have been cleared by a physician to participate in this Bootcamp.
If you answered Yes above, please list any and everything that pertains.
Remember, I am not responsible for what may happen if you have "At Risk" health conditions. My job is to provide safe modifications of exercises that allow you to participate in the Bootcamp class.
How would you rate your current fitness level? *
How did you hear about this Bootcamp? *
If a referral from a friend, what is their name?
Have a done what would be considered a bootcamp before? *
Check all that apply.
What is the name and location of the bootcamp(s) that you have done before?
In order to help me better plan my classes, I really need you to sign up for classes under the "Sign Up" section on my homepage at least 24 hours prior to the class. Will you plan on doing this? *
If you forget to sign up, you WILL NOT be kicked out of class or asked to leave. This is merely to help me better plan classes.
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