FusionFit BootCamp - Registration Form

Client Info

Name (first)

Name (last)

Street Address

Street Address Line 2

City

State

Zip

Phone (home)

Phone (cell)

Email address

Gender

Height

Desired Weight

Emergency Contact Name

Emergency Contact Number

Fitness Info

Daily Activity Level

Current Physical Condition

How many times per week do you exercise?

When I exercise I use....
just weights.
just cardiovascular exercises.
both weights and cardiovascular exercises.

List 3 health/fitness habits that you would like to change.

How serious are you about reaching your health/fitness goals?

What external factors have derailed your fitness progress in the past? (Check all that apply.)
Time
Money
No Facility
Procrastination
Lack of Support

In your opinion, why have you failed to 'stick with' previous fitness plans/goals? (Check all that apply.)
Discipline
Knowledge
Experience
Accountability
Lack of Expertise

Medical Info

Medical History (Check all that apply.)
I am currently pregnant
Heart disease runs in my family
I have diabetes

If known, what was your last cholesterol total?

Please check any that you may have experienced.
Neck injury
Asthma
Back injury or chronic pain
Knee injury or chronic pain
High blood pressure
Other (explain below)

Other injury if checked above

Is there any reason your physician would object to you exercising? If yes please explain.

Release and Waiver of Liability

Medical Release will be given at the first Boot Camp session.

Choose your bootcamp

FusionFit Apparel