Forever Fit Personal Training

To pay with a credit card: If you pay by check, please make it payable to the YWCA. Mail check to ForeverFit c/o Nancy Eisenman 2745 Sherwood Road, Bexley, OH 43209

SPECIAL EVENT BOOT CAMP ONLINE REGISTRATION/APPLICATION FORM:
First Name: *
Last Name: *
Date of Birth: *
Cell Phone: *
E-mail: *
Address: *
City: *
State: *
Zip Code: *
Home Phone: *
Class days are Tues.(9:30 am or 6:30 pm), Thurs.(9:30 am or 6:30 pm), Sat.(9:30 am only)
I will attend Boot Camp on these days (Click calendar on right to pick a day.):
I will attend at these times: *	9:30 am 6:30 pm
Additional day:
Additional time:	9:30 am 6:30 pm
Additional day:
Additional time:	9:30 am 6:30 pm
Emergency Contact - Name/Phone/Relationship: *
Rate Physical Condition 1-10 (10 being the best):
I understand that photos and video may be taken during the course of my participation in the ForeverFit Boot Camps or ForeverFit Personal Training (ForeverFit) sessions. These photos and videos will be used to promote current and future ForeverFit programs and events, but for no other purpose. By checking this box I give my expressed written consent for such use:
*	YES NO
How did you hear about us?
IMPORTANT WAIVER INFORMATION, PLEASE READ. By submitting this form, I certify that I am medically and physically able to participate in the ForeverFit Boot Camp (FFBC) and can use all facilities and equipment. I do hereby agree that the program, FFBC and its employees are not responsible or liable to me for any injury, accident or loss of personal property that may occur while participating in the boot camp. I do hereby release the program, FFBC and its employees from any claim or cause of action, which may have occurred as a result of any medical problem, known or unknown that I may have knowledge of presently or in the future. I verify that FFBC and its employees have made no personal promises or guarantees to me about achieving any measurable results by choosing to participate in the program. I agree to make FFBC aware of any/all injuries, physical, mental or medical limitations, and any medications that would be cause for concern prior to my beginning any training or exercise regimen. I fully understand that I have voluntarily chosen to participate in the program. I am working out and exercising at my own risk and release FFBC and its employees of any liability. I also fully acknowledge and understand the FFBC has no Liability Insurance for any public places where the program is held. I CERTIFY THAT I HAVE READ THIS AGREEMENT AND AGREE TO THE TERMS HEREIN.
	YES NO
Comments:
Code: NPHSBC
* = required info
You will receive a confirmation email once your registration is received.