Enroll

First Name

Last Name

Gender

male

female

Email

Phone

Date of Birth

Fitness Level

What is your current workout routine?

When was your last consistent workout?

Why do you want to join boot camp?

Fitness Goals

Please list any injuries or medical conditions (strictly confidential).

Please list any boot camps you have joined in the past.

Have you ever worked out with a personal trainer before?

Yes

No

Coupon code, voucher #, promo code

How did you hear about Cindy Lai Fitness?

Waiver & Release

In consideration for being permitted to participate in personal training sessions, fitness classes, programs or workshops (collectively, the ‘Activity’) offered by Cindy Lai and/or Cindy Lai Fitness (‘Cindy Lai Fitness’), as well as the benefits that I will derive from my participation in the Activity, I hereby represent and agree as follows:  1. Representations.  (a) I am physically fit and able to participate in the Activity, and I have no medical condition that would prevent my participation in the Activity; (b) I understand that it is my responsibility to consult with a physician regarding my participation in the Activity; (c) I acknowledge that I have had the opportunity to ask Cindy Lai Fitness any questions that I may have about the Activity that I believe are necessary in order to decide whether I am able to participate in the Activity and make the above representations.    2. Assumption of Risk.  I acknowledge that my participation in the Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries.  I understand that the specific risks can, and do, vary from one activity to another and that these risks range from minor injuries to catastrophic injuries, including paralysis and death.   3. Release of Liability.  I, on behalf of myself, heirs, successor, assigns, personal or legal representatives and estate hereby forever release, waive, discharge and covenant not to sue Cindy Lai Fitness from any and all liability from all claims, actions, suits or other proceedings resulting in any injury, death, accident, illness or property damage that I may suffer or sustain, regardless of fault, arising from or in connection with, my participation in the Activity.  4. Indemnification.  I hereby voluntarily release, forever discharge and agree to indemnify, defend and hold harmless Cindy Lai Fitness from and against any and all claims, actions, suits, proceedings, costs, expenses, damages and liabilities brought as a result of my participation in the Activity and the building or facilities where the Activity occurred and to reimburse Cindy Lai Fitness in full for any such expenses incurred.   5. Cindy Lai Fitness reserves the right to use any photograph taken of you relating to the Activity in promotional materials, brochures, blogs and websites.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

Type this verification code to continue.

<<	Feb 2012					>>
S	M	T	W	T	F	S
29	30	31	1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	1	2	3