Registration – Adventure Fitness Camp

Please note: All fields are required.

Camp and Payment Information

What camp are you joining?:
[select* 5 week camp "Whitley Village Cobham, Old Reedonians on 20-04-2021 at 09:15-10:00 AM" "Kate Staples bootcamp" "Camp 2 on 08/03/2020 at 06:30:00 AM" "Camp 3 on 08/31/2020 at 06:30:00 AM"]
Select your location:

Select your frequency:

Form of payment:

Personal Information

Name:

Email:

Phone:

Date of Birth:

Profession:

Address:

Address Continued:

City:

County:

Post Code:

Self Assessment & Additional Information

I rate my current fitness level as: (1-10):

How did you hear about us?

Name of Emergency Contact:

Emergency Phone Number:

Is this your first adventure boot camp:

Last Camp attended:

My Main goal is:

I was referred by:

Medical History

Enter N/A for any section which is Not Applicable for you.

Are you allergic to any medication? List medications:
Do you take any prescribed medication? List medications:
Do you suffer from epilepsy? List medications:
Are you anemic? List medications:
Do you have Diabetes? List medications:
Do you have High Blood Pressure? List medications:

Do you wear glasses or contact lenses?
Do you have Asthma?
Do you have Heart Disease? List medications:
Do you have Lung Disease? List medications:
Do you have Kidney Disease? List medications:
Do you have Liver Disease? List medications:

Have you ever had a severe neck injury? Describe:
Have you ever been knocked out? Describe:
Have you had a broken bone or fracture in the past 2 years? Describe:
Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:
Have you ever injured your back? Describe:
Describe any current pain you may be experiencing:

Do you have other physical conditions which cause pain? Describe:
Have you had any surgical procedures: Describe:
What are your goals for the next three months? Describe:
Have you had your body fat tested? Describe testing and results:
Are you training for a specific event? If yes, explain:

NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!

RELEASE
This release is entered into between the undersigned and Kate Staples Training Ltd, its officers, subsidiaries, affiliates, and executors in addition to the City of Kate Staples. The purpose of Kate Staples Training Ltd is to provide fitness instruction and coaching for various levels of athletes/individuals.

The undersigned hereby acknowledge that the following was explained to me and/or agree to the following:

1. Acknowledges that Kate Staples is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.

2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Kate Staples Training Ltd does not guarantee neither good nor bad will occur nor guarantees the training advice given by Kate Staples including Kate Staples Training Ltd will produce good nor bad results.

3. Acknowledges that the undersigned has been told if they feel tired, feel pain or feel out of the ordinary in any way either related to your training, or otherwise, that the undersigned should contact a physician at once.

4. Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, kung-fu, weight training, obstacle courses, and any other related sports are an extreme test of one's mental and physical limits and carry with it potential for damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of events/activities including the elements of a natural environment, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind Kate Staples Training Ltd for the undersigned participating in said sporting events and/or training for said sporting events.

The Undersigned agrees that this is the full agreement between the parties, that Kate Staples Training Ltd including Kate Staples nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion.

Customer client agrees to confidentiality with respect to Kate Staples Training Ltd and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Kate Staples Training Ltd. The undersigned agrees to a non-compete within a 50 mile radius of Kate Staples for a period of 5 years from date of participation.

Agree to Terms and Confirm Registration

I agree to all Terms and Conditions