Triangle Adventure Boot Camp in Raleigh, NC - womens fitness, group personal training
Triangle Adventure Boot Camp Registration
If you have any issues with the online registration form,
please email me at registration@trianglebootcamp.com.
Contact Information
* Required Field
Last name:
DOB:
mm/dd/yyyy
*
First name:
 *
*
Home
Phone:
Street
Address:
*
*
Work
Phone:
City:
*
*
Zip:
State:
Cell Phone:
*
Job Title:
Email:
*
Emergency
Contact Name:
 Emergency
Phone:
*
 *
Urgent Notications
Text to Cell
In the event of a last minute cancellation or venue change
because of weather or other emergency, campers will be
contacted via email or text by 5am.  Please select your
preferred method of communication in these situations.
Email
Alternate Email
Camp & Fitness Information
Site:
 Days per Week:
*
*
Camp:
 Payment:
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Membership Type:
 *
 T-shirt size:
Current
Fitness Level:
 How did you hear about
Triangle Adventure Boot Camp?
*
My main fitness goal is:
Please provide additional details about how you found us,
such your search words, referral name, or newspaper name.
Medical History
YES
 NO
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
2. Do you take any prescribed medication on a permanent or
semi-permanent basis?
3. Do you have a seizure disorder (epilepsy)?
4. Do you have diabetes; Type I (IDDM) or Type II (NIDM)?
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
7. Do you have or have you ever had Heart Disease?
8. Do you have or have you ever had Lung Disease?
9. Do you have or have you ever had Kidney Disease?
10. Do you have or have you ever had Liver Disease?
11. Do you have or have you ever had asthma?
12. Do you have or have you ever had severe neck injury?
13. Have you ever been knocked out?
14. Have you had a broken bone or fracture in the past two years?
15. Do you wear glasses or contact lenses?
16. Have you ever injured your back?
17. Do you have back pain?
18. Have you had knee pain in the past two years that has disabled you for
longer than a week?
19. Do you have other physical conditions which cause pain?
20. Have you had any surgical procedures?
21. Have you ever had your body fat tested?
22. Are you training for a specific event?
23. What is your current height in inches?
Please use the box below to explain ALL "yes" answers from above.
Informed Consent, Waiver, and Release Agreement
This waiver and release is entered into between the undersigned and Triangle Adventure Boot Camp, its instructors, officers,
affiliates, and executors.

The purpose of the Adventure Boot Camp Program offered by Jennifer Shevach is to provide fitness instruction and coaching
for various levels of athletes/individuals.

The undersigned hereby agrees to each of the following:
1.        Acknowledges that the instructor is not a physician and is not trained in any way to provide medical diagnosis or any
other type of medical advice.
2.        Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Triangle
Adventure Boot Camp does not guarantee neither good nor bad will occur, nor guarantees the training advice given by
Triangle Adventure Boot Camp or its instructors 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 and activities, 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 Triangle Adventure Boot Camp, its instructors, officers, affiliates, and executors 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 no representatives of Triangle Adventure
Boot Camp 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.

Write your full name in the box below to agree to the above terms.
Performance Pledge
In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have
established the following policies to which you will need to adhere. Please check each one.
I agree to limit my alcohol consumption during boot camp to less than 4 drinks per week.
I agree to use positive motivation to encourage those around me to do their best.
I agree to eat foods that nurish my body while attending boot camp.
I agree to attend boot camp as often as I possibly can.
I agree to arrive by 5:25am each morning of boot camp.
I agree to keep rude comments to myself, so that everyone feels welcome at TABC.
Multimedia Release
I understand that a group photo is taken each camp on the last Monday.  I give TABC permission to post that photo
to the group Facebook page.  If I do not wish to be in the photo, I will skip that day or let the instructor know.
Refund Policy
I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp
if, for reasons beyond my control, I am not able to complete the one I originally joined. Camp fees cannot be used
towards any other products or services provided by Triangle Adventure Boot Camp.
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