Free | BetterBodies Boot Camp

Current Boot Camp

September 2010

Dates: August 30 - October 1
Times: 6:00am (M-W-F), 8:00am (M-W-F), 9:30am (M-W), 5:30pm (M-W)

Location:

Winchester Country Club
1300 Senseny Rd.
Winchester, VA 22601
(map)

To register for your one (1) free trial session, please complete the form below:

First Name: Last Name: Address: City: State: Zip Code: Phone Number: Email Address:
Your Fitness Level:
Choose Your Boot Camp: Date You Plan to Attend:

Consent & Release of Liability:

Informed Consent

I give my consent to participate in the physical fitness program designed and administered by Anderson Fitness Solutions, Inc.

1. Benefits
Participation in a regular program of physical activity has been shown to produce positive physiological adaptations. These adaptations may cause changes that include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power, and endurance.

2. Risks
I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack).  I hereby certify that I know of no medical problem that would increase my risk of illness and injury as a result of participation in a regular exercise program. By agreeing to this consent form I understand that I am personally responsible for my actions throughout the duration of my exercise program, and that I waive the responsibility of Anderson Fitness Solutions, its officers, employees, agents, independent contractors, or representatives, if I should incur any injury of any nature whatsoever as a result of my participation in any exercise program administered by Anderson Fitness Solutions, its officers, employees, agents, or representatives.

3. Confidentiality and Use of Information
I have been informed that the information obtained in this personal fitness training program will be treated as privileged and confidential and will consequently not be released or revealed to any person other than officers, employees, agents, independent contractors, or representatives of Anderson Fitness Solutions who need such information to provide fitness consulting and related services to me, without my express written consent.  I do, however, agree to the use of any information that is not personally identifiable with me for research and statistical purposes so long as same does not identify me or provide facts that could lead to my identification.  I also agree to the use of any information for the purpose of consultation with other health/fitness professionals, including my doctor.


Agreement and Release of Liability

1. In consideration of being allowed to participate in the activities and programs of Anderson Fitness Solutions, I do hereby waive, release and forever discharge Anderson Fitness Solutions and its officers, agents, employees, representatives, independent contractors, and all others from any and all responsibilities or liability for injuries or damages resulting from my participation in activities recommended by Anderson Fitness Solutions.  I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities as recommended by Anderson Fitness Solutions.

2. I understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment, are potentially hazardous activities.  I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved.  I hereby agree to expressly assume and accept any and all risks of injury or death.

3. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation in any of the activities and programs of Anderson Fitness Solutions or use of equipment or machinery except as hereinafter stated.  I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery.  I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have recommendations concerning these fitness activities and equipment use.  I acknowledge that I have either had a physical examination and have been given any physician’s permission to participate, or that I have decided to participate in activity and/or use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities.

I accept these terms:
I do not accept: