Enrol Online

Enrol Online

	04-Sep-2010
FULL NAME
EMAIL ADDRESS
ADDRESS
POSTCODE
PHONE (M)
PHONE (H)
PHONE (W)
DATE OF BIRTH
NAME OF DOCTOR
NAME OF CLINIC
EMERGENCY CONTACT
PHONE NUMBER FOR EMERGENCY CONTACT
ANY INJURIES/MEDICAL CONDITIONS/LIMITATIONS?
IF YES, DO YOU HAVE DOCTORS APPROVAL FOR EXERCISE?	Yes No
WHERE DID YOU HEAR ABOUT OUR BOOTCAMP?

If I fall sick, have work commitments, become pregnant, obtain an injury, or need to discontinue for any other reason, no refund will be given, as I agree my place has been secured for the entire 5 week program. If I fall ill or suffer from any kind of physical impairment during the first 14 days I will be given a transfer only to the next bootcamp but no refund. All clients agree to hand in all documents of information requested, and ensure payment is made in full, prior to commencement of the scheduled fitness test. Physical Revolution reserves the right to change the conditions without notice and accepts no responsibility for participant's health, safety or injury or loss during the 5 week course. I agree to inform Physical Revolution of any injuries, medical conditions, disorders, diseases, limitations or implications, whether they affect physical activity or not. I accept full responsibility and will not in any way hold Physical Revolution responsible if I have or have not informed them of any injuries, medical conditions, disorders, diseases, limitations or implications.

DECLARATION I understand Bootcamp is a rigorous 5-week fitness program and realize some activities are high intensity that involve running on uneven surfaces, stair climbing, strength and endurance activities and declare myself to be in good health and fit to participate in Bootcamp. I accept full responsibility for my participation in all exercises, and anything that I incur physically during this course.

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