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Mount Kisco Boot Camp Registration

Westchester Somers Boot Camp Class
REGISTRATION

You now have 2 options:
A. You can print this form and send it in with payment by mail
B. Register Online
Fill out the online form below to register via internet. Click on Submit to go to the payment page.
Payment Page: Pay via Paypal. Choose your class and finish your online registration. A PayPal account is not required to pay via PayPal.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

If paying by check, please make check out to:
Westchester Mount Kisco Boot Camp
3 Bridge Lane
Somers, NY 10598
GetFit@WestchesterBootCamp.com
Phone: (914) 960-4494

Boot Camp Registration form for Returning Campers

You will be notified to schedule your pre-camp evaluation (if needed for your program).

Name

Email Address

All of my information is the same:

Yes | No (If you select No, only update the information that has changed).

Address		City
State / ZIP	/	Profession
Date of Birth	(mm/dd/yyyy)
Phone Number		Work Number
Fax Number		Cell Phone

I rate my current fitness level as a (1-10), ten being high.

I was referred by:

How did you hear about us?:

Please specify publication / website / friend or other referral:

This is my first camp:

Yes | No

If you answered "no", when was the last camp you attended:

My Main goal is:

Name of Emergency Contact & Phone Number

What camp are you joining? | What time are you attending? | Choose your camp frequency and cost.

Form of payment:

$329 (5 days/week) | *$299 (3days/week) *This option is for those who have other commitments in the early a.m. Since it is only a 4-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out! You can do it!! ) !

Comments:

NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!

RELEASE: (Scroll to read the entire Release).
This release is entered into between the undersigned and Westchester Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the City of Westchester. The purpose of Westchester Adventure 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: 1. Acknowledges that Carla Braca and/or trainers/personnel affiliated with this program are not physicians and are not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. 2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Westchester Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Carla Braca including Westchester Adventure Boot Camp will produce good nor bad results. 3. 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. 4. 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 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 Westchester Adventure 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 Westchester Adventure Boot Camp including Carla Braca 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. Customer client agrees to confidentiality with respect to Westchester Adventure Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Westchester Adventure Boot Camp. The undersigned agrees to a non-compete within a 50 mile radius of Westchester for a period of 5 years from date of participation.

PERFORMANCE PLEDGE
In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have established the following policies to which you will need to adhere. Please read and check each one.
I still agree to all Performance Pledge items.

I agree to all Terms and Conditions listed above

Electronic Signature

Date (MM/DD/YYYY)

Notes or Message:

For More Information Contact Carla at (914) 960-4494 or e-mail GetFit@WestchesterBootCamp.com