Registration Form
Personal Information
Name (first, last)		Address
City		State / ZIP	/
Profession		Country
Date of Birth	(mm/dd/yyyy)	Phone Number
Work Number		Fax Number
Email Address		T-shirt size	Select a size X-Small Small Medium Large X-Large XX-Large

Self Assessment & Additional Information
I rate my current fitness level as a (1-10), ten being high.	1 - Low 2 3 4 5 6 7 8 9 10 - High
I was referred by:
How did you hear about us?:
Please specify publication / website / friend or other referral:
This is my first camp:	Yes | No
If you answered "no", when was the last camp you attended:
My Main goal is:
Name of Emergency Contact & Phone Number	|

Checkmark the following:
	I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp. Any violation will result in twenty push-ups per occurrence.
	I will remember to set my alarm and be at camp on time.
	I understand that diet and nutrition will effect my fitness goals and performance during boot camp.
	I will bring a positive attitude, and expect to have fun

Agreement and Signature

I agree to all Terms and Conditions listed above

Electronic Signature

Date (MM/DD/YYYY)