Bootcamp Online Registration Form

Please complete the following information and provide as much detail as possible in the medical history and health sections. Once the form is completed and you’ve clicked the button to register, an email will be sent to you with further instructions.

privacy_iconImportant Note about Your Privacy!

FRESH! Fitness and Bootcamp 101 respect your privacy and personal information.  These details are for informational purposes only and will never be shared with anyone outside our company…EVER!  We will send you messages related to Bootcamp and our health and fitness related tips.  You can always unsubscribe by contacting us or clicking the opt-out link in any message.

Person Information
Your Primary Bootcamp Location *
NOTE:  You can attend sessions at ANY location
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 *
Phone Number *
Extension
Secondary Phone Type
Phone Number
Extension
Weight (lb) *
Height (in) *
Gender *
Male
Female
What is Your Primary Goal *
In what area of the city do you LIVE
In what area of the city do you WORK
How did you hear about Bootcamp 101? *
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!

Heart Condition or Chest Pain
Do you Smoke?
High Blood Pressure
Low Blood Pressure
Asthma
Arthritis
Hernia
Back Problems
Pregnant or Breastfeeding
Joint Problems
Medications (Type, Dosage)
Recent Surgeries
Physical Exam in last 12 months
Acceptance of Waiver and Policies

Consent to Waiver *
Yes No

Consent to Policies *
Yes No
Please enter the Security Code shown below:
If you are unable to read the Security Code just REFRESH your browser to get another code
n/a
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