M Johnson Fitness | Fitness Camp Registration

-Step 1-
First Name:	*
Last Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
Email:
How did you hear about us?	*
Name of person who referred you? (if applicable)

-Step 2-
Location	*
I rate my current fitness level:	*
Do you take any prescribed medications on a permanent or semi-permanent basis?	*
List Medication: (if applicable)
Do you have Diabetes?	*
Do you have High Blood Pressure (hypertension)?	*
Do you have or have you ever had any of the following diseases?
Heart?	*
Lung?	*
Kidney?	*
Liver?	*

Do you have asthma?	*
Have you had surgery in the past 6 months?	*
If Yes, When and Why?
Do you have any physical limitations?	*
If Yes, Describe:

-Step 3-
I agree that I will not consume alcohol during the month of Boot Camp. But if I choose to, I understand that doing so can affect my results in a negative manner.
	*	(check box to agree)
I agree not to eat foods that are fried, made with lots of sugar, have saturated fat or anything else not deemed healthy by the boot camp instructor during the course of Boot Camp. But if I choose to, I understand that doing so can affect my results in a negative manner.
	*	(check box to agree)
I agree to show up for Boot Camp every day. But if I do not, I understand that doing so can affect my results.
	*	(check box to agree)
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 and after" photos could be used for promotional purposes with written authorization.
	*	(check box to agree)
I understand there is no refund policy, but I can receive a credit towards a future camp if I'm not able to complete the one I originally joined due to situations outside of my control. Camp fees cannot be used towards any other products or services provided by M Johnson Fitness.
	*	(check box to agree)
I will remember to set my alarm and be at camp on time.
	*	(check box to agree)
I have read and agree to the Release Waiver. [click to read]
	*	(check box to agree)

Anticipate amazing results...

» 5-12 pounds of weight loss
» Up to 3% body fat loss
» 25% increase in strength
» 25% improvement in endurance
» Nutritional education
» Better relaxation
» 100% gain in self-confidence
» Four weeks of fun, challenging activities designed to help you meet your goals