Women's Adventure Fitness Boot Camp in San Jose, bootcamp for women, adventure boot camp, womens fitness program, womens weight loss, exercise camp, womens camp, exercise, workout programs, outdoor exercise

San Jose Adventure Boot Camp for Women Registration

You now have 2 options:
A. You can print this form and send it in with payment by mail
B. Register Online
Fill out the online form below to register via internet. Click on Submit to go to the payment page.
Payment Page: Choose your class and finish your online registration.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

If paying by check, please make check out to:
San Jose Adventure Boot Camp
3635 Union Avenue
San Jose, CA 95124

If you choose option A, Print this page and mail it in with payment.

If you choose option B: Fill out the form below and Click on SUBMIT.

You will be notified to schedule your pre-camp evaluation (if needed for your program).

Name

Billing Address

City

State

ZIP (Billing)

Profession

Country

Date of Birth

(mm/dd/yyyy)

Phone Number (billing)

Work Number

Fax Number

Email Address

I rate my current fitness level as a (1-10), ten being 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

Which Camp are you joining? | What Time are you attending? | Choose your Days/per Week & price from the 2nd pull down menu.

*please select the correct price for your camp

Form of payment:

* Camp 7C-08 is a 3 Week 'Mini-Camp.' Special pricing: 5-Day $240,* 4-Day $195, and *3-Day $150. *These options are for those who have other commitments in the early a.m. Since it is only a 4-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out! You can do it!! ) !

* Camps with "SC" are for Silver Creek camp, "C" is Campbell location. 9:30 AM is only available in Campbell.

Note: If paying by check, please print this online form and mail or fax it in with payment. *Please note - we cannot guarantee your reserved spot until payment is received.
For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time to process your registration. PLEASE verify all credit card numbers are entered before sending. Please provide correct billing address and phone.

Credit Card Number:	no spaces	Exp. Date:	/
Name on Credit Card:		*CVC Code:**	(security code)

*Visa and MasterCard
In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.

$325 (5 days/week) | *$260 (4days/week)| *$195 (3days/week) *These options are for those who have other commitments in the early a.m. Since it is only a 4-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out! You can do it!! ) !
**There are special prices for 'Mini-Camps' and Special Combination Camps

MEDICAL HISTORY (If you are a returning camper, only complete the sections that have changed.)

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?

List Medications:

2. Do you take any prescribed medication on a permanent or semi-permanent basis?

List Medications:

3. Do you have a seizure disorder (epilepsy)?

List Medications:

4. Do you have diabetes Adult or Juvenile?

5. Have you ever been found to be anemic (low blood count)?

6. Do you have High Blood Pressure (hypertension)?

List Medications:

7. Do you have or have you ever had the following diseases?

Heart Disease:

Lung Disease:

Kidney Disease:

Liver Disease:

8. Do you have asthma?

List Medications:

9. Have you ever had a severe neck injury?

Describe:

10. Have you ever been knocked out?

Describe:

11. Do you wear glasses or contact lenses?

12. Have you had a broken bone or fracture in the past 2 years?

Describe:

13. Have you ever injured your back?

Describe:

14. Do you have back pain?

15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?

Describe:

16. Do you have other physical conditions which cause pain?

Describe:

17. Detail any surgical procedures:

18. What are your goals for the next three months?

19. Have you had your body fat tested?

If yes, what percent is it?

20. 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 San Jose Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the City of San Jose. The purpose of San Jose Adventure Boot Camp 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 Brett A. Riesenhuber 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 San Jose Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Brett A. Riesenhuber including San Jose Adventure Boot Camp 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 San Jose Adventure Boot Camp 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 San Jose Adventure Boot Camp including Brett A. Riesenhuber 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 San Jose Adventure Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of San Jose Adventure Boot Camp. The undersigned agrees to a non-compete within a 50 mile radius of San Jose for a period of 5 years from date of participation.

Checkmark the following:
I agree to be coachable/trainable during my 4 weeks of boot camp in order to achieve by health and fitness goals.

I commit to give 100% effort to myself and my fitness at each class and the remaining 23 hours per day.

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 and one lap per occurrence.

I agree to set my alarm and show up for Boot Camp ON TIME every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors. Any violation will result in twenty push-ups and one lap per occurrence.

I commit to respect my coach and my peers by not talking while the coach is instructing. If the coach is speaking it is likely information that my peers and I need to hear to make our boot camp experience more safe and effective.

I understand that diet and nutrition will effect my fitness goals and performance during boot camp. I choose to commit to eating and drinking foods and beverages that will accelerate my success AND consume no alcohol for my 4 week program.

I agree to show up for Boot Camp every day that I have registered for.

I understand that photos or video may be taken during the course of my involvement in Boot Camp, which may be used for promotional purposes. I understand that my "before & after" photos will not be used for any promotional purposes unless I give written authorization.

I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if I'm not able to complete the one I originally joined. Camp fees can not be used towards any other products or services provided by San Jose Adventure Boot Camp. If you are unable to begin the camp you have registered for you may cancel before camp begins, there will be a $50 cancellation fee.

I will bring a positive attitude, and expect to have fun!

I agree to all Terms and Conditions listed above (By submitting this form you agree to all terms)

Electronic Signature

Date (MM/DD/YYYY)

For More Information, Contact us at (408) 558-1800 or e-mail Brett@SanJoseBootCamp.com