North Atlanta Adventure Boot Camp - Fitness - Rosa Hurst, Instructor

Boot Camp Re-Enlistment Form & Release

Thank you for registering for another exciting North Atlanta Boot Camp. Please complete and submit the short form below (note that required fields are highlighted in red text).

North Atlanta Boot Camp Re-Enlistment Form

In order to use this form, each statement below must be true. Please check each box to confirm your agreement.

I have attended an North Atlanta Boot Camp within the past six (6) months.

I confirm that my personal contact information has not changed from my original registration.

I confirm that my emergency contact, medical history, and medical status have not changed.

Should any of these statements be untrue, then you will need to fill out a new registration form; otherwise, your original agreements on file are still binding.

First and last name:

E-mail address:

Emergency Contact:

Emergency Contact Number:

Date of Birth:

Camp date:

ALPH = Alpharetta BC = Big Creek MASH = Mashburn MENs = Men's
NF = North Forsyth SPRNGS = Dunwoody/Sandy Springs

Camp time :

5:15am / 5:30am (ALPH, BC, MASH, SPRNGS)
6:15pm (ALPH, FAIR, MENs)

Number of days per week:

4 WEEK CAMPS:

5 days (20 sessions)

4 days (16 sessions)

3 days (12 sessions)

2 1/ 2 WEEK CAMPS:

5 days (12 sessions)

1 WEEK ADVANCED CAMPS:
(REPEAT CAMPERS ONLY!!!)

5 days per week $79

I rate my current
fitness level as a:

(1-10), 10 being high

Comments:

RELEASE

This release is entered into between the undersigned and North Atlanta Camp. The purpose of North Atlanta 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 Rosa Hurst / Bellana Fitness, LLC. is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.
Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that North Atlanta Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by North Atlanta Boot Camp 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 contact a physician at once.
Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, kung-fu, 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 inherent dangers of the natural elements, 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 and North Atlanta Boot Camp for the undersigned participating in said sporting events and/or training for said sporting events.

The Undersigned agrees that this is the full agreement between the parties, that North Atlanta Boot Camp, 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.

Check the following:

I agree that I will not consume alcohol during the month of Boot Camp. Any violation will result in twenty push-ups per occurrence.

I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence.

I agree not eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp. Any violation will result in twenty push-ups per occurrence.

I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors. Any violation will result in twenty push-ups per occurrence.

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 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 am not able to complete the one I originally joined (due to injury or major illness). Camp fees cannot be used towards any other products or services provided by North Atlanta Adventure Boot Camp, Inc. This credit is nontransferable. There is no cash refund.

I understand that by electing to receive the "re-enlisted" camper discount that I will not receive another free North Atlanta Boot Camp t-shirt.

I will remember to set my alarm and be at camp on time.

Your signature will be required at the time of your evaluation, and you agree to the terms now!

PAYMENT

NOTE: Your registration will be confirmed only after receipt of payment. Space is limited, so please submit your payment immediately.

Please select your payment method:

Paying online with credit card.

Mailing check.

By submitting this form, you are agreeing to the terms above!

For more information call 404-978-5362 or write to info@bellanafitness.com.