Person Information
Your Primary Bootcamp Location *
NOTE: You can attend sessions at ANY location
Please select a bootcamp type & primary location
Downtown
Westwinds (NE)
West Springs/Cougar Ridge (SW)
Wentworth/Aspen (SW)
Private Camps – Corporate
Private Camps – Bridal/Specialty
First Name *
Last Name *
Your PRIMARY Email Address *
Date of Birth (MM-DD-YYYY) *
Company Name
Job Title
Street Address1 *
Street Address2
City *
Province *
Postal Code *
Primary Phone Type *
Please select a phone1 type
Work
Home
Mobile
Other
Phone Number *
Extension
Secondary Phone Type
Please select a phone2 type
Work
Home
Mobile
Other
Phone Number
Extension
Weight (lb) *
Please select a weight (lb)
80 or less
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
Height (in) *
Please select a height (in)
< 4’0″
4’0″
4’1″
4’2″
4’3″
4’4″
4’5″
4’6″
4’7″
4’8″
4’9″
4’10″
4’11″
5’0″
5’1″
5’2″
5’3″
5’4″
5’5″
5’6″
5’7″
5’8″
5’9″
5’10″
5’11″
6’0″
6’1″
6’2″
6’3″
6’4″
6’5″
6’6″
6’7″
6’8″
6’9″
6’10″
6’11″
7’0″
Gender *
What is Your Primary Goal *
Please select a primary goal
Weight loss
Improved fitness
To look better
Better nutrition habits
Reduce medical risk factors
Increased energy
Lower risk of injury
Rehabilitate a current injury
Training for a specific sport
To complete a challenge or event
Slow the aging process
Stress Management
Lifestyle Balance
Other
In what area of the city do you LIVE
Please select a living quadrant
Downtown
NW
NE
SW
SE
Outside city
In what area of the city do you WORK
Please select a working quadrant
Downtown
NW
NE
SW
SE
Outside city
How did you hear about Bootcamp 101? *
Please select a how did you hear about us?
Email from FRESH!
Flyer
Poster
Friend
Family Member
Coworker
My Company
Google Search
Other Web Search
Online Advertisement
Sunterra Market
Lawn Sign
My Chiro/Physio/Massage Therapist
Other Local Business
The method isn’t listed here!
Name of person or company who referred you to us
Health History Comments
please enter any specific medical details, injuries, or information
that the Bootcamp 101 team should know prior to you starting this program
Health & Medical Background
Check all that apply
For any checked boxes, please provide a detailed explanation in the text area ABOVE
as this will help us provide you with a safer and more effective camp experience!
Acceptance of Waiver and Policies
Waiver & Release of Liability
Consent to Waiver *
Bootcamp 101 Policies & Procedures
Consent to Policies *
Please enter the Security Code shown below:
If you are unable to read the Security Code just REFRESH your browser to get another code