GENERAL INFORMATION
*Full Name:
*Telephone
*Email
Address
City
State
Zip Code:
Date of Birth:
(mm/dd/yyyy) Tee Shirt Size
Small
Medium
Large
XLarge
XXLarge
XXXLarge
Camp Date You Are Registering For:
Location: Nicholas Ball Camp Park - 8734 Ball Camp Pike – Within Nicholas Ball Park From I-40/75, take the Cedar Bluff exit (exit 378), go 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
What location are registering for?
Nicholas Ball Park
Carl Cowen Park
How did you hear about us?
Internet
Flyer
Friend
Other
If other, please specify:
Emergency Contact Name
Emergency Contact Telephone
What is your main goal?
Are you training for a specific event?
Yes
No
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 not 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
Yes
No
Private
Please specify medicines:
Do you take prescribed medication?
Yes
No
Private
If yes, please list:
Do you have a seizure disorder?
Yes
No
Private
Do you have diabetes?
No
Yes
Type I
Type II
Have you ever been found to be anemic (low blood count)?
Yes
No
Private
Do you have High Blood Pressure
Yes
No
Private
Do you have or have you
ever had heart disease?
Yes
No
Private
Do you have or have you ever had:?
Yes
No
Private
Do you have or have you
ever had kidney disease?
Yes
No
Private
Do you have or have you
ever had liver disease?
Yes
No
Private
Do you or have you
Yes
No
Private
Do you have or have you
ever had a severe neck injury?
Yes
No
Private
Have you ever been knocked out?
Yes
No
Private
Have you had a broken bone
or fracture in the past 2 years?
Yes
No
Private
Do you wear glasses or contact lenses?
Yes
No
Have you ever injured your back?
Yes
No
Private
Do you have back pain?
Yes
No
Private
How Often?
Constantly
2-3 days per week
Occasionally
--
Do you have other physical conditions, which cause pain?
Yes
No
Private
Please explain:
Have you had any surgical procedures?
Yes
No
Private
Please explain:
Have you had knee pain in the past 2 years that has disabled you for longer than a week?
Yes
No
Private
Please explain:
Have you ever had your
body fat tested?
Yes
No
Private
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.
Location: Carl Cowen Park - 10058 S. Northshore Drive, Knoxville 37922
