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PT FITNESS| HEART • POWER • FOCUS

Boot Camp Contact Form
Please contact ptfitnessbootcamp@sbcglobal.net OR call 817-653-7272
for questions.

E-mail Address: *

Name: *

Phone Number: *

Address: *

Age: *

Height: *

Weight: *

How did you hear about PT Fitness Boot Camps? *

How would you rate your current fitness level? *

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes
No

Do you feel pain in your chest when you perform physical activity?

Yes
No

In the past month, have you had chest pain when you were not performing any physical activity?

Yes
No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes
No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes
No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes
No

Do you know of any other reason why you should not engage in physical activity? If yes, please explain.

What is your current occupation?

Does your occupation require extended periods of sitting?

Yes
No

Does your occupation require extended periods of repetitive movements?

Yes
No

Does your occupation require you to wear shoes with a heel (dress shoes)?

Yes
No

Does your occupation cause you anxiety (mental stress)?

Yes
No

What, if any, recreational activities (golf, tennis, skiing, etc.) or hobbies (reading, gardening, working on cars, exploring the Internet, etc.) do you participate in?

Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? If yes, please explain.

Have you ever had any surgeries? If yes, please explain.

Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? If yes, please explain.

Are you currently taking any medication? If yes, please list.

Is there any other medical information you would like to share?

What is your T-Shirt size? *

What is your main fitness goal?

Which Boot Camp will you attend? *

By submitting, you are agreeing that the information you have provided above is accurate and truthful. *

I understand that photos or videos may be taken during this boot camp for promotional purposes. *

I understand all fees for PT Fitness boot camps agreement are immediately earned by PT Fitness. All fitness service fees are non-refundable unless specifically stated otherwise. View Edit Delete I am aware that PT Fitness boot camp and training services are provided in various locations. Using any of the facilities involves the risk of injury to you or your guest, whether you or someone else causes it. Specific risks vary from one activity to another and the risks range from minor injuries to major injuries, such as catastrophic injuries including death. In consideration of your participation in the activities offered by PT Fitness, you understand and voluntarily accept this risk and agree that PT Fitness, its officers, directors, employees, volunteers, agents, independent contractors and facility will not be liable for any injury, including, without limitation, personal bodily, or mental injury, economic loss or any damage to you, your spouse, guests, unborn child, or relatives resulting from negligence of PT Fitness or anyone on PT Fitness behalf or anyone using the facilities whether related to exercise or not. Further, you understand and acknowledge that PT Fitness does not manufacture fitness or other equipment at any of the facilities used, but purchases or leases equipment. You understand and acknowledge that PT Fitness is providing a service and may not be held liable for defective products. By selecting "yes" you acknowledge and agree that you have read the foregoing and know of the nature of the activities and agree to all the terms of this agreement. Checking this box acknowledges that you have read and agree. *

* Required