Camp and Payment Information
What camp are you joining?
2017 Camp 1: February 6 ($199)
2017 Camp 2: March 13 ($199)
2017 Camp 3: April 10 ($199)
2017 Camp 4: May 8 ($199)
2017 Camp 5: June 12 ($199)
2017 Camp 6: July 10** ($99)
2017 Camp 7: July 31 ($199)
2017 Camp 8: September 4 ($199)
2017 Camp 9: October 9 ($199)
2017 Camp 10: November 6** ($99)
2017 Camp 9: November 27 ($199)
What time are you attending?
5:30 - 6:30 am
Choose your camp frequency and cost.
3 days/week for 4 weeks- 5:30 am = $199
3 days/week for 2 weeks- 5:30 am = $99
Form of payment:
Referral Information - Must be completed to receive your discount!
Referral Program Rules
For each camper you refer to camp, you'll earn a $50 discount towards your own camp! To qualify for the discount, both you and the friend you refer Attention All Campers! To receive the discount: must attend the same camp!
(1) Enter the full name of each friend you referred to this boot camp into one of the boxes below.
Please note that the following limits are in effect:
• maximum of 4 referrals allowed for a $250 camp
• maximum of 3 referrals for a $200 camp, and
• maximum of one referral for either a $150 or $100 camp.
Please enter your referrals in the correct row below.
Thank you in advance for your referrals!
$250 tuition: Enter up to 4 friends, one full name per box:
$200 tuition: Enter up to 3 friends, one full name per box:
$125 or $100 tuition: Enter up to 1 friend's full name in the box:
(If you are a returning camper, only complete the sections that have changed.)
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)?
4. Do you have diabetes Adult or Juvenile?
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
7. Do you have or have you ever had the following diseases?
8. Do you have asthma?
9. Have you ever had a severe neck injury?
10. Have you ever been knocked out?
11. Do you wear glasses or contact lenses?
12. Have you had a broken bone or fracture in the past 2 years?
13. Have you ever injured your back?
14. Do you have back pain?
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
16. Do you have other physical conditions which cause pain?
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 doctors advice before beginning any health/fitness/nutrition program!
This release is entered into between the undersigned and Anthem Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the City of Anthem. The purpose of Anthem Adventure Boot Camp 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 Terry Donatto is not a physician and is 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 that Anthem Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Terry Donatto including Anthem Adventure Boot Camp 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 Anthem Adventure Boot Camp 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 Anthem Adventure Boot Camp including Terry Donatto 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.
Customer client agrees to confidentiality with respect to Anthem Adventure Boot Camp and all services provided by same. The undersigned agrees to refrain from disclosing, directly or indirectly, any and all aspects of Anthem Adventure Boot Camp. The undersigned agrees to a non-compete within a 50 mile radius of Anthem for a period of 5 years from date of participation.
Checkmark the following:
I agree not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree not to eat or say the words
Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors. Any violation will result in twenty push-ups per occurrence.
I understand that photos or video
may be taken during the course of my involvement in 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 I'm not able to complete the one I originally joined. Camp fees
can not be used towards any other products or services provided by Anthem Adventure Boot Camp.
I will remember to set my alarm and be at camp on time.
I understand that diet and nutrition will effect my fitness goals and performance during boot camp.
I will bring a positive attitude, and expect to have fun