Retreat Medical Form

Please complete the following questions to the best of your ability. If you have any questions or concerns, please contact Nannette.

Name *
Current Fitness Levels *
Select One:
By signing this document, I acknowledge that I have been informed of the need to obtain a physician's examination and approval prior to beginning this exercise program. I fully understand that the program may be strenuous and choose to participate completely voluntarily. I accept all responsibility for my health and resultant injury or mishap that may affect my well-being or health in any way. I hold harmless of any responsibility the instructor, facility or any persons involved with this program or testing procedures. I understand that I am responsible for my attendance and that there are no refunds for missed days. Should there be circumstances beyond my control, I am able to, at the discretion of the coach, receive credit for the unused portion of camp to use on future Boot Camp days. Camp credit is subject to approval and availability in future camp.
Date *
acuity Block
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