RobZFitness Boot Camp Packages

Click on link to purchase your session

5:00am Package Sessions

9:30am Package Sessions

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Boot Camp

Waiver and Release of Liability

Registration Note: We cannot guarantee your space will be reserved if you do not contact us by phone (813) 571-3700 or email Rob@RobZFitness.com. This form must be completed prior to the start of your boot camp session. Using the Add to Cart button will notify us of your purchase, and we will contact you within 24 hours.

You now have two options:

A. You can print this form and send it by mail, or

B. Click the “Add to Cart” link to register immediately “SECURE” online. If you do not have a PayPal account, simply click on the “Click Here” link at the bottom of the payment page, and you will be able to enter your credit card information. You do NOT need a PayPal account.

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MEDICAL HISTORY

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?

2. Do you take any prescribed medication on a permanent or semi-permanent basis?

3. Do you have a seizure disorder (epilepsy)? Yes / No

4. Do you have diabetes Adult or Juvenile? Yes / No

5. Have you ever been found to be anemic (low blood count)? Yes / No

6. Do you have High Blood Pressure (hypertension)? Yes / No

List Medications:

7. Do you have or have you ever had the following diseases?

Heart Disease: Yes / No

Lung Disease: Yes / No

Kidney Disease: Yes / No

Liver Disease: Yes / No

8. Do you have asthma? Yes / No

9. Have you ever had a severe neck injury?

Describe:

10. Have you ever been knocked out?

Describe:

11. Do you wear glasses or contact lenses? Yes / No

12. Have you had a broken bone or fracture in the past 2 years?

Describe:

13. Have you ever injured your back?

Describe:

14. Do you have back pain?

Never | Seldom | Occasionally | Frequently with vigorous exercise or heavy lifting

15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?

Describe:

16. Do you have other physical conditions which cause pain?

Describe:

17. Detail any surgical procedures:

18. What are your goals for the next three months?

19. Have you had your body fat tested?

If yes, what percent is it?

20. Are you training for a specific event?

If yes, explain:

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

In consideration of my participation in the fitness programs of RobZFitness Boot Camp I hereby release and covenant not to sue RobZFitness Inc, RobZFitness Boot Camp, Rob Zulkoski, its officers, directors, shareholders, employees, agents, and contractors, from any and all present and future claims resulting from ordinary negligence, for personal injury, or death arising as a result of participation in the fitness program(s) of RobZFitness Boot Camps, as a result of my participation in RobZFitness Boot Camp and use of any equipment and or facilities, and as a result of engaging in any activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, which may be made by family estate heirs, assigns, or me.

Further, I am aware that the activities and programs in which I have decided to participate may range from vigorous cardiovascular activity (i.e., aerobics, running, calisthenics) to the strenuous exertion of strength training (i.e., free weights, weight machines). I understand that these and other physical activities at RobZFitness Boot Camp involve certain risks including by not limited to, death, and serious neck and spinal injuries, which could result in complete or partial paralysis, heart attacks, and injury to bones, joints, or muscles. I am voluntarily participation in program activities with the knowledge of dangers involved and hereby agree to accept any and all inherent risks of personal injury, or death.

I further agree to indemnify and hold harmless RobZFitness Inc, RobZFitness Boot Camp, Rob Zulkoski, its officers, directors, shareholders, employees, agents, and contractors, for any and all claims arising as a result of my engaging in program activities, or any activities incidental thereto, wherever, whenever, or however the same occur.

I understand that this waiver is intended to be as broad and inclusive as permitted by laws of the State of Florida and agrees that if any portion of this Waiver and Release are held invalid, the remainder of the Waiver and Release will continue in full force and effect.

I affirm that I am of legal age and am freely signing this agreement. I have read this from and fully understand that by signing this form, I am giving up legal rights and/or remedies that may be available to me for the ordinary negligence of RobZFitness Boot Camp or any of the parties listed above.

Please initial:

________ I understand and voluntarily agree to all the conditions and agreements listed on this WAIVER and RELEASE.

________ I understand that there are risks of injury involved in participating in exercise, and I voluntarily assume such risks.

________ I attest that I am physically fit to participate in the personal or group fitness program.

________ I attest that I am 18 years old or older. (If not, legal guardian must sign.)

Printed Name of Participant _________________________________

Signature of Participant _____________________________________ Date ___________

Signature of Parent/Guardian ________________________________ Date ___________

(If participant is under 18 years of age)

The Undersigned agrees that this is the full agreement between the parties, that RobZFitness 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.

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Signature

_______________________________

Printed Name

_______________________________

Date

Rob@RobZFitness.com

3438 Lithia Pinecrest Road, Valrico, Florida 33596 (813) 571-3700