Registration Logo

Oxygen Boot Camp Registration and Waiver

(*) - Required Fields

If you have previously registered with us,
then click here to proceed to online payment


Full Name: *
Gender: Male
Female
Date of Birth: *
Street Address: *
State: *
City: *
Zip: *
Home Phone: *
Cell Phone: *
Emergency Contact: *
Emergency Contact Number *
Email: *
Age: *
How did you hear about us?
(ex: newspaper, website or search engine, flyer, friend, other)		 *
Goals (6 months, 1 year): *
Medical Issues or Physical Limitations: *

Risk Assessment
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? Yes
 
2. Do you feel pain in your chest when you do physical activity? Yes
 
3. In the past month, have you had chest pain when you were not doing physical activity? Yes
 
4. Do you lose your balance because of dizziness or do you ever lose consciousness? Yes
 
5. Do you have a bone or joint problem (back, knee, hip) Yes
 
6. Is your doctor currently prescribing drugs (for ex. water pills for your blood pressure or heart condition)? Yes

Please check if any apply:
High Blood Pressure
High Cholesterol
Diabetes
Cigarette smoking
Smoked in the past
Family history of heart disease
Abnormal resting EKG

Oxygen Boot Camp Available Session

Please choose any of the sessions you would like to participate in.
You must at least choose one.

Summer Session 1: June 7th-July 2nd
**check schedule for class locations** *
Any 1 Day
Any 2 Days
Any 3 Days
Any 4 Days
Summer Session 2: July 12th-August 7th
**check schedule for class locations** *
Any 1 Day
Any 2 Days
Any 3 Days
Any 4 Days
Summer Session 3: August 16th- Sept. 11th
**check schedule for class locations** *
Any 1 Day
Any 2 Days
Any 3 Days
Any 4 Days
End of Summer Special

    Informed Consent and Release of Liability

    • I hereby consent to voluntarily engage in boot camp activities for improvement of my general health and well being.  The levels of exercise that I perform will be based upon my cardio respiratory and muscular fitness, assessed initially based on information I share with the trainer.  I am also fully aware that I am advised to obtain a physician consent to exercise.  I agree to participate in accordance with the personal trainer's instruction.  Trained, personal fitness trainers will provide leadership to direct my activities, monitor my performance, and evaluate my effort.
    • If I am taking prescribed medications, I will provide the trainer with a complete listing of the medications I take.  I understand that the personal trainer will not make medication recommendations, but advise me to check with my physician to see if there are any contradictions related to any of the medicines.  I agree to inform my personal trainer of any changes my doctor or I make with regard to the use of prescription drugs.
    • I have been informed that during my participation in Boot Camp , I will voluntarily complete the physical activities unless symptoms, such as fatigue, shortness of breath, chest discomfort, or similar occurrences appear.  It is my obligation to inform the trainer of my symptoms.
    • I understand that during Boot Camp, physical touching and/or positioning of my body may be necessary to assess my muscular and bodily reactions to specific exercises, and to ensure that I am using proper technique.  I express consent to physical contact for these reasons.
    • I understand and have been informed that there exists the possibility of adverse changes and/or risk of bodily injury occurring during exercise including, but not limited to:abnormal blood pressure, fainting, dizziness, disorders of heart rhythm; in rare instances heart attach, stroke, paralysis, or death; and injuries to muscles, ligaments, tendons, and joints. I have been told every effort will be made to minimize these occurrences by proper staff observation.  I fully understand and accept the risks, and knowing these risks, it is my desire to participate as herein indicated and to assume full responsibility for my participation and actions.  I agree to hold Linda Alexander, Oxygen and Iron Works, Inc., and contractors or employees of Oxygen and Iron Works or any associated companies harmless for injury, cardio respiratory incident, or death.
    • I, for myself, and on behalf of my spouse, heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless, Linda Alexander, Oxygen and Iron Works, Inc.,and their agents, contractors, and/or employees ("Releasees") with respect to any and all injury, disability, or loss or damage to person or property, whether due to or arising from negligence or carelessness of the "Releasees" or otherwise.
    • I agree that this INFORMED CONSENT AND RELEASE OF LIABILITY AGREEMENT is to be construed and governed under the laws of the State of Virginia, U.S.A. and that if any portion is held invalid, the balance hereof shall continue in full legal force and effect.  In signing this AGREEMENT, I acknowledge that I have read this entire Agreement, that I understand its terms, that I have had the time and opportunity to read and ask questions regarding the Agreement.  Also, I have signed the Agreement knowingly and voluntarily, and that by signing it, I understand that I am giving up substantial legal right I might otherwise have.
  I agree to the above *
Date:  *


To complete the registration process, please choose "Submit Registration" below:



or