Chi-Rho Sports & Fitness -    "Taking Your Body to New Heights"
REGISTRATION
 
Print the 3 forms and bring them to bootcamp or REGISTER ONLINE BELOW
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
REGISTRATION
NAME
ADDRESS
CITY
ZIP
DATE OF BIRTH
CELL PHONE
EMAIL
EMERGENCY CONTACT
EMERGENCY PHONE
CAMP SITE
FITNESS LEVEL
REFERRED BY
FORM OF PAYMENT
CHECK
CASH
PAYPAL
GIFT CERTIFICATE
MEDICAL HISTORY QUESTIONNAIRE
Are you allergic to any medications?
Do you take any prescribed medications?
Do you have any seizure disorders
Do you have diabetes
Are you anemic (low blood count)?
Do you have hypertension (high blood pressure)?
Any history of heart, lung, liver, kidney disease?
Do you have asthma?
Have you suffered from a severe neck injury?
Do you wear glasses or contacts?
Any physical conditions or injuries which cause pain?
Any surgical procedures?
If you answered YES to any questions, please describe below
List goals you wish to attain through Chi-Rho Fitness Bootcamp
I have read and agree to Waiver & Release viewable by clicking "Chi Rho Fitness Waiver" link at top of page
I agree
I Agree to show up for boot camp everyday unless it is excused absence
I agree
I understand that photos or video may be taken during the course of my involvement in bootcamp, which may be used for promotional purposes
I agree
I understand there is no refund policy but I can receive a credit for unused portion of camp if I am unable to complete my camp
I agree
I WILL BE ON TIME
I agree
Fitness Bootcamp
BACK TO BASICS 6 WEEKS
Price: $150.00
 
 
 
 
 
 
Website Builder provided by  Vistaprint