Register For A Fitness Bootcamp

Basic Information
Name
Street	Apt#
City	State Zip
Email
Phone
How Did You Hear About NLP?
Emergency Contact Name, Number, & Relationship
My Current Fitness Level Is? (1-low, 10-high)
Date of Birth
What time will you attend the majority of your workouts?
Which Bootcamp will you participate in?
Respond to each question below.
	1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
	2. Do you feel pain in your chest when you do physical activity?
	3. In the past month, have you had chest pain when you were not doing physical activity?
	4. Do you lose your balance because of dizziness or do you ever lose your consciousness?
	5. Do you have a bone or joint problem that could be made worse by change in physical activity?
Enter Description	5B. If yes, please explain further.
	6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?
	7. Do you know of any other reason why you should not do physical activity?
	8. Are you currently taking any supplements, pills, or other weight loss agents?
	9. Do you require special needs or assistance?
	10. Are you Hypoglycemic? (Suffer from low blood sugar levels)
	11. Are epileptic? (Suffer from seizures)
	11A. If yes, when was your last one?
Enter symptoms, if any.	11B. Symptoms?
	12. Are you Diabetic?
	12A. If yes, is it controlled by insulin or medication?
	13. Do you have high blood pressure that requires medication to control?
	14. Do you have back pain?
	15. Do you have any joint pain or injuries that may be worsened with physical activity?
Women's Fitness Bootcamp Waiver of Liability In consideration of me being allowed to participate in the Women's Fitness Bootcamp (“Activity”), I agree: 1. I understand dangers may be caused by my own actions, or inaction’s, the actions or inaction’s of others participating in the Activity, and the condition. I understand the nature of Women's Fitness Bootcamp Activities held by Next Level Performance LLC and acknowledge my experience and capabilities and believe I am qualified to participate in such Activity. I further acknowledge that I am aware that the activity will be conducted in facilities open to the public during the Activity. I further agree and warrant that if, at any time, I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. I FULLY UNDERSTAND that: (a) Women's Fitness Bootcamp Activities held by Next Level Performance LLC involve risks and dangers of SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“Risks”); (b) these Risks in which the Activity takes place or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (C) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my participation in the Activity. 3. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS Next Level Performance LLC, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the “Releasees” herein) from all liability, claims, demands, losses, or damages on account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, or anyone on my behalf makes a claim against any of the Releasees named above, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. 4. I ACKNOWLEDGE that by signing this release I give Next Level Performance LLC full permission to use images or video I may appear in by participating in this event in things such as promotional items, advertisements, and commercial product royalty-free. I further acknowledge that copies of such items do not need to be approved by me, and that I am not entitled to any compensation for the use of my image or likeliness in said items. I surrender my rights to royalties or compensation for the sale of any products or items bearing these images produced or associated with Next Level Performance or any person or entity related, expressed or implied to Next Level Performance LLC. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND IT’S TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. By typing your name into this field, you are hereby providing a digital signature.