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ABOUT DORSEY

CONTACT DORSEY

Dorsey's Power Training
865-386-4163
Knoxville Personal Trainer

Complete the registration form below to register for an upcoming bootcamp.
Once you've complete the application form, you will be directed to a confirmation page where
you may pay online to complete your registration.

* Indicates required field.

GENERAL INFORMATION

*Full Name:

*Telephone

*Email

Address

City

State Zip Code:

Date of Birth:

(mm/dd/yyyy) Tee Shirt Size

Camp Date You Are Registering For:

(see below for dates)

3 Day Hard Knox Bootcamp		2 Day Hard Knox Bootcamp
March 17th – April 11th IN SESSION! Days: Monday, Wednesday, Friday Time: 6:00 AM Location: Nicholas Ball Camp Park Cost: New Hard Knox Camper $200.00/ $150.00 (Limited Time Only) save $50.00		March 18th – April 10th Days: Tuesday, Thursday Time: 6:00 AM Location: Nicholas Ball Camp Park Cost: New Hard Knox Camper $150.00 $120 (Limited Time Only) save $30.00

April 21st – May 16th Days: Monday, Wednesday, Friday Time: 6:00 AM Location: Nicholas Ball Camp Park Cost: New Hard Knox Camper $200.00/Hard Knox Troops $150.00		April 22nd – May 15th Days: Tuesday, Thursday Time: 6:00 PM Location: Nicholas Ball Camp Park Cost: New Hard Knox Camper $150.00/Hard Knox Troops $120.00

May 26th – June 20th Days: Monday, Wednesday, Friday Time: 6:00 AM Location: Carl Cowen Park Cost: New Hard Knox Camper $200.00/Hard Knox Troops $150.00		May 27th – June 19th Days: Tuesday, Thursday Time: 6:00 PM Location: Carl Cowen Park Cost: New Hard Knox Camper $150.00/Hard Knox Troops $120.00

Location: Nicholas Ball Camp Park - 8734 Ball Camp Pike – Within Nicholas Ball Park 37931 (I-40/75 exit (378) Cedar Bluff, north on Cedar Bluff Rd. approx. 2 miles, turn left on to Middlebrook Pike, approx. 2 miles to Ball Camp Pike turn right, on to Ball Camp Pike, park ¼ mile on right.)

Location: Carl Cowen Park - 10058 S. Northshore Drive, Knoxville 37922 Take I-40 to the Campbell Station Road exit (exit 373). At the bottom of the exit ramp go south to Kingston Pike. At Kingston Pike turn left and go about ¾ mile to a traffic light and turn right on Concord Road. Travel about 1 mile until Concord Road dead ends into Northshore Drive. Make a left on Northshore Drive travel about 3 miles or so and the field is on the right.

What location are registering for?

How did you hear about us?

If other, please specify:

Emergency Contact Info

Emergency Contact Name

Emergency Contact Telephone

Your Goals for Bootcamp

What is your main goal?

Are you training for a specific event?

Medical History

The following information is collected so your bootcamp leader is aware of any medical conditions or issues. The information you provide is strictly confidential. If you prefer no to provide this information online, please select "private" for the appropriate questions below. Please note, you should always seek your doctor’s advice before beginning a fitness program.

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

Please specify medicines:

Do you prescribed medication?

If yes, please list:

Do you have a seizure disorder?
Do you have diabetes?		Have you ever been found to be anemic (low blood count)?
Do you have High Blood Pressure		Do you have or have you ever had heart disease?
Do you have or have you ever had lung disease?		Do you have or have you ever had kidney disease?

Do you have or have you ever had liver disease?		Do you or have you ever had asthma?

Do you have or have you ever had a severe neck injury?		Have you ever been knocked out?

Have you had a broken bone or fracture in the past 2 years?		Do you wear glasses or contact lenses?

Have you ever injured your back?		Do you have back pain?
		How Often?

Do you have other physical conditions, which cause pain?

Please explain:

Have you had any surgical procedures?

Please explain:

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

Please explain:

Have you ever had your
body fat tested?

RELEASE

This release is entered into between the undersigned and Hard Knox Boot Camp, its officers, subsidiaries, affiliates, and executors. The purpose of the Boot Camp program 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 the trainers working for Hard Knox Boot Camp 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 Hard Knox Boot Camp and its trainers do not guarantee neither good nor bad will occur nor guarantees the training advice given by these trainers, 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 Hard Knox Boot Camp, the employees of Hard Knox Boot Camp, the City of Farragut or the City of Knoxville, 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 no representative of Hard Knox 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.

Yes, by checking this box I agree to the terms above.

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.

I agree not to use foul language during Boot Camp.
I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Hard Knox Boot Camp directors.
I will arrive at camp ON TIME. (Any violation of the above statements will result in twenty push-ups per occurrence.)
I understand that photos or video may be taken during the course of my involvement in Hard Knox Boot Camp, which may be used for promotional purposes.
I understand that my "before & after" photos will not be used for any promotional purposes unless I give written authorization.

I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if, for reasons beyond my control, I am not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services provided by Hard Knox Boot Camp.
Yes, by checking this box I agree to the terms above.