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CAMPER ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF ; JCF HEALTH & FITNESS, LLC. CAMPER ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER BUYER’S PARTICIPATION IN THE PHYSICAL ACTIVITES. BUYER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT AR NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BUYER, SLIP AND FALL BY BUYER, OR AN UNKNOWN HEALTH PROBLEM OF BUYER. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, BUYER AFFIRMS THAT BUYER IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYISCAL ACTIVITIES. BUYER ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND BUYER AGREES THAT IT IS THE RESPONSIBILITY OF BUYER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF BUYER TO TAKE PART IN JCF FITNESS & HEALTH, LLC PHYSICAL ACTIVITIES. BY SIGNING THIS AGREEMENT, BUYER ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR EXCEEDING HIS OR HER PHYSICAL LIMITS.

DATED: March 26, 2019

First Camper's Name

First Name*

Last Name*

Phone*
First Camper's Date of Birth*
First Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
First Camper's Signature*
Second Camper's Name

First Name*

Last Name*
Second Camper's Date of Birth*
Second Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Third Camper's Name

First Name*

Last Name*
Third Camper's Date of Birth*
Third Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Fourth Camper's Name

First Name*

Last Name*
Fourth Camper's Date of Birth*
Fourth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Fifth Camper's Name

First Name*

Last Name*
Fifth Camper's Date of Birth*
Fifth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Sixth Camper's Name

First Name*

Last Name*
Sixth Camper's Date of Birth*
Sixth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Seventh Camper's Name

First Name*

Last Name*
Seventh Camper's Date of Birth*
Seventh Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Eighth Camper's Name

First Name*

Last Name*
Eighth Camper's Date of Birth*
Eighth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Ninth Camper's Name

First Name*

Last Name*
Ninth Camper's Date of Birth*
Ninth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Tenth Camper's Name

First Name*

Last Name*
Tenth Camper's Date of Birth*
Tenth Camper's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Camper's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
You are receiving this email because you opted in at our website or at a trial session.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

PHYSICAL ACTIVITY READINESS

Physical activity should not be hazardous for most people. The PAR-Q has been designed to identify those individuals who should seek medical attentions prior to beginning a physical fitness program. 

Please answer all questions accurately and honestly to allow us to fully determine your individual needs. 


Body Fat % *

HEIGHT *

WEIGHT *

HOW DID YOU HEAR ABOUT US?
1. Do you have high cholesterol?*
No
Yes
2. Has your doctor ever said that you have heart trouble?*
No
Yes
3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity?*
No
Yes
4. Has your doctor ever told you that your blood pressure was too high?*
No
Yes
5. Are you over 65 years of age and not accustomed to vigorous exercise?*
No
Yes
6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program?*
No
Yes

The following information will be treated as privileged information:

1. Do you ever feel weak, fatigued, or sluggish?*
No
Yes

2. How many meals do you eat each day? *

3. Do you know how many calories you eat in a day? *
4. Do you eat breakfast?*
No
Yes
5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.)*
No
Yes
6. Do you crave sugary foods?*
No
Yes
7. Do you need several cups of coffee to keep you going throughout the day?*
No
Yes
8. Do you often experience digestive difficulties?*
No
Yes
9. Proper nutrition can increase the body's ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you?*
No
Yes

10. How long have you been exercising?
11. Have you reached and maintained your goals?*
No
Yes
12. Are you happy with the way you look and your health?*
No
Yes
13. On a scale of 1 to 10, how serious are you about achieving your goals?*

Please list your desired fitness goals:


Desired Body Fat: *

Desired Weight: *

Desired Waist Size: *

Desired Dress or Pant Size: *

I plan to exercise (times a week): *
I am interested in:
Aerobics Classes
Free Weight Training
Cardiovascular Training
Circuit Training
I would like to:
Increase Muscle Tone
Lose Body Fat
Increase Stamina
Increase Strength/Lean Mass
Improve Overall Health
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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