trainerjay.com offers you a wide range of
Fitness services, including but not limited to Boot Camps, Personal Training
Packages, Corporate Training, Professional Consultations, Home Gym Setup, and
Athletic Training Services.
Registration For Boot Camp - Must be completed...yes now.
Full Name*:
E-mail Address*:
Address*:
City*:
Zip*:
Profession*:
Date of Birth*:
Select Camp Date and Time*
Select Number of Days per Week*
3 Days Per Week:$240
(20% savings) Mon-Wed-Fri 4 Days Per Week:$320
(20% savings) Mon-Tues-Wed-Thurs Not Currently Available.
Select Shirt Size*
Emergency Contact & Phone*:
Home Phone*:
Work Phone:
Fax Number:
I rate my current fitness level as a*:
(1-10), ten being high
I was referred by:
My main goal is to*:
How did you find us?
MEDICAL HISTORY
* All medical fields are required
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 Adult or Juvenile?
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 the following diseases? Heart Disease: Lung Disease: Kidney Disease: Liver Disease:
8.
Do you have asthma?
9.
Have you ever had a severe neck injury?
10.
Have you ever been knocked out?
11.
Do you wear glasses or contact lenses?
12.
Have you had a broken bone or fracture in the past 2 years?
13.
Have you ever injured your back?
14.
Do you have back pain?
15.
Have you had knee pain in the past 2 years that has disabled you for longer than a week?
16.
Do you have other physical conditions which cause pain?
17.
Please detail any surgical procedures:
18.
What are your goals for the next three months?
19.
Have you had your body fat tested?
If yes, what percent is it?
20.
Are you training for a specific event?
If yes, what event?
NOTICE: It is wise to seek your doctors advice before beginning
any health/fitness/nutrition program!
RELEASE
This release is entered into between the undersigned and Trainerjay Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the Cities of
Danville and San Ramon, CA. The purpose of TrainerJay Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals.
The undersigned hereby acknowledge that the following was explained to me and/or agree to the following:
Acknowledges that it is recommended to consult a physician prior to starting any health/fitness/nutrition program.
Acknowledges that Jay Corbett, CPT, is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. I am aware that he agrees to maintain her current CPR certification.
Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that
TrainerJay.com does not guarantee neither good nor bad will occur nor guarantees the training advice given by
TrainerJay.com will produce good nor bad results.
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 notify the Boot Camp Director and contact a physician at once.
Acknowledges that boot camps, aerobic classes, running, 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/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
TrainerJay.com for the undersigned participating in said sporting events and/or training for said sporting events.
Boot Camp client shall not, after completing boot camp, engage directly or indirectly, either personally or as an employee, associate partner, partner, manager, agent or otherwise, or by means of any corporate or other device, in the outdoor fitness or boot camp fitness business within
Alameda County.
The Undersigned agrees that this is the full agreement between the parties, that
TrainerJay.com nor anyone else has not 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.
Checkmark the following:
* All boxes must be checked
I agree to show up for Boot Camp every day I have signed up for unless I have notified my Boot Camp director in advance or it is an excused absence from my doctor.
I understand that photos or video may be taken during the course of my involvement in Boot Camp, which may be used for promotional purposes. I understand that my "before & after" photos will not be used for any promotional purposes unless I give a separate written authorization.
I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if I’m not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services provided by
TrainerJay.com.
I understand that diet and nutrition will affect my fitness goals and performance during boot camp.
I also will: bring a positive attitude; respect others with varied fitness levels; set my alarm and be at camp on time; plan to have fun!
I have read and agree to the above terms and conditions
