Sign-Up Now!


I am interested in:*
For Boot Camp, Please select the session:
Name:*
Address:*
City, State, Zip:*
Phone:*
Email:
Emergency Contact:*
Emergency Phone:*
How did hear about PAC?:
Comments:
1. Do you have any known cardiovascular problems? If yes, please explain*
2. Do you have diabetes? If yes, how long?*
3. Has your doctor ever told you that your blood pressure was too high or too low? If yes, please explain*
4. Are you taking any medication? If yes, please list the medication and what they treat*
5. Do you have any current or prior injuries or orthopedic problems? If yes, please list and state current condition*
6. Do you have any other medical conditions not previously mentioned?*

Informed Consent & Client Release

I voluntarily consent to engage in PAC's Fitness Programs which includes a health assessment, exercise test, and/or training. I understand that during some tests and training I may be encouraged to work at a maximum effort and at any time may ask to terminate the test or training. Even though those participating in training/testing will be observed, I understand that it is my responsibility to monitor my own condition throughout the procedures and should any unusual symptoms occur, cease participation immediately and inform the test or program administrator of the symptoms. Such symptoms could include but are not limited to: nausea, difficulty breathing, chest discomfort, and joint or muscle pain. I also realize that is it not possible to specifically list each and every individual risk. However, knowing, understanding, and appreciating the material risks and reasonably anticipating that other injuries and even death are a possibility. I hereby expressly assume all delineated risks or injury which could occur by reason of my participation in this training program.


In the event an emergency situation occurs, I am financially responsible for any emergency services that may be necessary. I agree to assume all risks of the fitness testing and training, and hereby release the Performance Athletic Center, Miracles Fitness, and any of its agents or employees from any and all health claims, suits, losses or causes of action for damages, injury, or death, including claims for negligence arising out of or related to my participation in the fitness assessments and training programs.


I acknowledge that I have had a physical examination and have been given permission to participate by my physician, or that I have decided to participate without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs, and use of equipment.


The undersigned agrees to a non-compete clause within a 20 mile radius from Rio Grande, NJ for a period of 3 years from date of participation. I also agree that photos or videos may be taken during the course of my involvement in Boot Camp, which may be used to promotional purposes.
Informed Consent & Release *
By checking this box I agree that I have read the foregoing carefully and agree to all its content. By putting my name below in the signature box I agree that this online signature takes place of and represents my actual signing.
Signature:*
powered by Doodlekit™ Free Website Builder by Doodlebit™ Website Company