Date of Birth Select Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31Select Month 01 Jan 02 Feb 03 Mar 04 Apr 05 May 06 Jun 07 Jul 08 Aug 09 Sep 10 Oct 11 Nov 12 DecSelect Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029*
I rate my current fitness level as a (1-10), ten being high: 1-low 2 3 4 5 6 7 8 9 10-high
I was referred by: (Full Name, Email or Website)
Is this your first Camp? When was the last session you attended: ===== No Yes
What is your main goal or reason for joining Boot Camp:
Name of Emergency Contact & Phone Number:
Are you currently taking any medications? ===== No Yes
Do you have any medical conditions that may preclude you from participating in rigorous physical activities? ===== No Yes
Do you suffer from any diseases such as Diabetes, Liver, Lung, Heart or Kidney disease? ===== No Yes
Do you have any physical conditions or previous injuries that may preclude you from participating in rigorous physical activities?
===== No Yes
*NOTICE*: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!
This release is entered into between the undersigned and WorkoutLA, its officers, subsidiaries, affiliates, and executors in addition to the City of Los Angeles. The purpose of WorkoutLA is to provide fitness instruction, coaching, and nutritional advice 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 the WorkoutLA staff are not physicians and are 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 WorkoutLA does not guarantee either good or bad results will occur nor does it guarantee training advice given by the staff.
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 their training, or otherwise, that the undersigned should contact a physician immediately.
4. Acknowledges that personal training, boot camps, aerobic classes, martial arts, kick boxing, running, weight training, obstacle courses, and any other related activities are an extreme test of one's mental and physical limits and carry with them potential for damage or loss of property, serious injury and death. That the undersigned assumes the risks of participating in these types of 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 WorkoutLA, including WorkoutLA staff, for the undersigned participating in said activities and/or training for said activities.
The Undersigned agrees that this is the full agreement between the parties, that neither WorkoutLA nor anyone else has 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.
The Undersigned agrees to confidentiality with respect to WorkoutLA and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of WorkoutLA. The undersigned agrees to a non-compete within a 50 mile radius for a period of 5 years from date of participation.
I agree to all Terms and Conditions listed above.
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Document Blockchain ID: cCI3Amjt2K3OgZc3WGQLIgkvvimegDIFKsEOLO0rNNs1wfElMQp8aJbRkmS0n13y, Signed on: , Signor 1 given identity: [email protected], email verified by user, Login with Google Secure OAuth, IP Address: , Via browser: , Running on: , Language: , Timezone: , Resolution: , Destruction Date: , Document last modified prior to signature:
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