Date & Program
You may attend any camp time on a daily basis regarless of which time you select!
5 Camp VIP commitment covers a 6 month period ($95 per camp/$79 per month).
10 Camp VIP commitment covers a 12 month period ($83 per camp/$69 per month).
5 and 10 Camp packages- fees will debited on the 1st day of each camp at the per camp price.
5 Camp package 1 camp freeze permitted.  10 Camp package 2 camp freezes permitted.


Contact Information



Body Weight & Goals
What are your health and fitness goals?
Check all that apply: *
 


Physical Activity & Nutrition


Medical Information
Regular physical activity is safe for most people. However, some individuals should check with their doctor before they start an exercise program. To help us determine if you should consult with your doctor before starting an exercise program at Body Bionics, please read carefully and honestly answer the following questions. All information will be kept confidential.
Please complete the following: *
 YesNoN/A
Has a physician ever told you or are you aware that you have a heart condition?
Have you ever experienced a stroke?
Do you or have you smoked within the last six months?
Do you have high blood pressure?
Do you have high cholesterol?
Has anyone in your immediate family (parents, brothers, sisters) had a heart attack, stroke or cardiovascular disease before the age of 65 (if you are a woman) or 55 (if you are a man)?
Do you have diabetes?
Do you have a joint or bone problem that may be made worse by a change in your physical activity?
Are you a female over 54 years of age or a male over 44 years of age?
Do you consider yourself to have an inactive lifestyle?
Are you overweight?
Do you have any of the following: asthma, epilepsy, emphysema or arthritis? If yes, list below.
Do you feel pain in your chest when you engage in physical activity?
Do you feel pain in your chest when you are NOT engaged in physical activity?
Have you ever had unusual shortness of breath at rest or with mild exertion?
Do you ever suffer from dizziness or fainting spells?
Are you currently taking medications? If yes, list below.
Women: Are you pregnant or have you been pregnant within the last three months?
I have answered the above accurately and completely. I understand that my medical history is an important factor in the development of my fitness program and that certain medical/physical conditions which are known to me, but which I do not disclose to Body Bionics may result in serious injury to me. If any of the above conditions change, I will immediately inform Body Bionics. I, knowingly and willingly, assume all risk of injury resulting from my failure to disclose accurate, complete, and updated information in accordance with the above questionnaire.


Waiver of Liability & Informed Consent
I have enrolled in a program of strenuous physical activity including but not limited to cardiovascular and resistance training by Body Bionics. I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this exercise program.  In consideration of my participation in the exercise program, I for myself, my heirs and assigns, hereby release Body Bionics and its partners* from any claims, demands and causes of action arising from my participation in the exercise program by Body Bionics.  I fully understand that I may injure myself as a result of my participation in the exercise program and I hereby release Body Bionics and its partners* from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat related injuries/illnesses, knee/foot/low back injuries and any other illness, soreness or injury however caused, occurring during or after my participation in the exercise program. In addition, I understand that Body Bionics frequently captures images of its boot camp sessions and participants via photo and/or video.  I am aware that these images may contain photos and/or videos of me.  I further understand that Body Bionics owns these images and the right to use them for marketing purposes including but not limited to website postings and printed materials. *Partners include but are not limited to businesses and or organizations that provide access to and use of their facilities where Body Bionics hosts exercise programs.   

By registering and submitting payment, I acknowledge that I have read, understand and agree with the above statements and conditions and agree to abide by them.


Payment Information
Visa
MasterCard
American Express
Discover