Ventura Adventure Boot Camp - Camarillo Registration Form
ARE YOU A Re-Enlisting CAMPER? Save time by following this link to our short Re-Enlist form.

Thank you for registering for the Ventura Adventure County Boot Camp - Camarillo Location. While our Boot Camp program is designed to be effective & safe for a majority of the population & fitness levels, it is a vigorous exercise program and is not "just for anyone". If you have ANY DOUBTS whatsoever about this program being appropriate for you, please call or email our office to discuss your particular situation prior to registering or submitting payment. Regardless of cause, any cancelled registrations will incur a $55.00 cancellation fee.

To register for our program, please enter your information by answering all the questions and submit the form below to complete the registration process. Once you submit this registration form, you will be prompted to make your payment through Pay Pal or to send in your check. Your spot in camp is only secure once we receive both your registration form and your payment.

If you will be mailing in your payment or prefer to complete the form offline, please download our registration form.

Submitting registration does not guarantee your acceptance into this program. VCABC reserves the right to refuse service to anyone who fails to meet, to agree to, or to abide by, our policies and program procedures; or, who we feel -based on our professional opinion & evaluation -this program is not appropriate.


Ventura County Adventure Boot Camp
CAMARILLO CAMP REGISTRATION FORM

NOTE: Qualifying returning campers click here to register with our shorter "Re-Enlistment Form"!!
PART 1: PERSONAL INFORMATION  (Confidentiality & Privacy Policy)

First Name                        Last Name

Residence Address:

City:

Zip:

Home Phone

Cell Phone

Job Title/Position

Work Phone

Email Address

Date of Birth: (MM/DD/YYYY)
Present Weight (in pounds)
 Height (in inches)

Emergency Contact

Emergency Contact Phone

I rate my current fitness level as a
(use scale of 1-10, 10 being highest = elite athlete)

How did you hear about boot camp?

If by Referral or Other, please list below:
Physician Name
 Physician Phone

PART 2: PROGRAM OPTIONS

I am signing up for the following camp:
CAMARILLO CAMP

 

Payment Options (must select one)

I will pay online using PAYPAL

I will mail a check or money order.
(made out to True North Fitness)

I have a gift certificate to apply & will call in to activate it

Attendance Options for (must select one): All programs are 4 weeks @ 1 hr/day.

4 Days a week (M,Tu, Th, F), $249

Improve your results with Program Enhancement Options  (additional cost)

I will be signing up for a nutrition coaching option, please call me to arrange my eval.

I will be signing up for peak performance coaching, please call me to arrange my eval.

I will not be adding an enhancement option to my basic boot camp program.
I will be at the group orientation.

The best times and days to reach me for scheduling my eval are:

NOTE: ADD-ON PACKAGES PROVIDE ADDITIONAL SUPPORT AND ONE-ON-ONE MEETINGS. IF YOU ARE SELECTING AN ADD-ON PROGRAM ALONG WITH YOUR BASIC BOOT CAMP, THEN YOU WILL NEED TO CALL OR EMAIL OUR OFFICE TO SET UP YOUR PRE-CAMP ASSESSMENT.

» Nutrition clients need an additional 75 minute consult

[ total 90 minute consult ]

» Performance clients need an additional 45 minute consult

[ total 75 minute consult ]

» Optimum results clients need an additional 90 minute consult

[ total 105 minute consult ]

This is my first camp:

If you answered "no", when was the last camp you attended:

PART 3: MEDICAL & EXERCISE HISTORY  (Confidentiality & Privacy Policy)

 NOTE:  All “YES” answers require a written explanation in the box below
Otherwise your registration is incomplete.

 Yes No

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 Type I (IDDM) or Type II (NIDM)?

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?

   
 

Heart Disease
 

Lung Disease
 

Kidney Disease
 

Liver Disease

8.

Do you have or have you ever had asthma?

9.

Have you ever had a severe neck injury?

10.

Have you ever been knocked out?

11.

Have you had a broken bone or fracture in the past 2 years?

12.

 Have you ever had a stress fracture or shin splints before?

13.

Have you ever injured your back?

14.

Do you have back pain?
Never    Seldom    Occasionally    Frequently with vigorous exercise or heavy lifting

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.

Have you had any surgical procedures?

18.

 Do you smoke? If so, describe how much, how often and what you smoke.

19.

 Have you ever smoked? If so, describe how long ago you quit, what you smoked and for how long.

20.

 Are you currently on a "diet", enrolled in a weight loss program, or
following a "weight management" meal plan of any type while you are in boot
camp? Please explain in detail in the explanations box below.

21.

What are your goals for the next three months?

22.

Have you had your body fat tested?
24.

Are you training for a specific event? If yes , describe:

23.

Do you have ANY physical limitations that restrict your ability to exercise or to execute normal, functional movements? Or has a medical professional ever directed you to limit your exercise, or that you not participate in an exercise program which is not directly administered by a medical professional?

PLEASE EXPLAIN ALL “YES” ANSWERS IN DETAIL BELOW. PLEASE REFERENCE THE QUESTION NUMBER.

PLEASE DESCRIBE ANY PRIOR EXERCISE/SPORTS HISTORY & EXPERIENCES [GOOD & BAD]

If you are unsure about the definition of any terms in this form, or of your ability to participate in this program, please call us first to clarify. Do not assume and DO NOT REGISTER; regardless of cause any cancelled registrations will incur a $55.00 cancellation fee.

PART 4: PARTICIPATION AGREEMENT, INFORMED CONSENT WAIVER, and LIABILITY RELEASE & NONCOMPETE AGREEMENT

This agreement is entered into willingly by me, an individual, and the entities or persons listed below in section (A) on account of my desire to participate in a voluntary fitness program. I affirm my understanding that this fitness program is an extreme test of a person's physical and mental limits and carries with it the potential for serious injury, death, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, personal health condition, lack of hydration, inadequate nourishment, equipment, vehicular traffic, and actions of other people including, but not limited to, participants, spectators, or trainers. I hereby assume all risks of participating in this activity. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. In consideration of my application and permitting me to participate in the Adventure Boot Camp program, I hereby take action for myself, my executors, administrators, next of kin, successors, and assigns as follows:

  1. Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from Boot Camp training, THE FOLLOWING ENTITIES OR PERSONS:

    2. True North Pioneering, Inc., Ventura County Adventure Boot Camp, the City of San Buenaventura, the City of Camarillo, the City of Thousand Oaks, the County of Ventura, Ventura Parks Department, Camarillo Parks Department, Thousand Oaks Parks Department, the State of California Parks Department, and Ventura Unified School District, and their instructors, officers, affiliates, employees, agents, board members, and executors

  2. Indemnify and Hold Harmless the entities or persons mentioned in the above paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise.
     
    I understand the purpose of the Adventure Boot Camp Program offered by True North Pioneering, Inc. is to provide fitness instruction and coaching for various levels of athletes/individuals.

The undersigned hereby acknowledges that the following was explained to me and/or agree to the following:

  1. Acknowledges that the instructor and assistant coaches are not physicians and are not trained in any way to provide medical diagnosis or any other type of medical advice.
  2. Acknowledges that coaching/training provided by True North Fitness & Health is designed to help increase health and fitness and Adventure Boot Camp is another tool for teaching athletes/individuals about themselves, and True North Fitness does not guarantee any specific fitness or health results by my participation.
  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 their training, or otherwise, that they should stop the training session and should contact a physician at once.
  4. Acknowledges that they are fit, do not have a physical injury or condition that would preclude participation in regular vigorous exercise and have not been advised otherwise by a qualified medical person, and they have a regular medical physician they can contact regarding any medical problems that they might develop.
  5. Acknowledges I am asking to participate in this progressive fitness program strictly for personal reasons to improve my fitness conditioning and acknowledge that as a result I will be exposed to the proprietary training techniques of Adventure Boot Camp which are intended for same; consequently, I acknowledge I am not a trained or certified fitness professional, and agree that I am not authorized to record the programming or daily plans of Adventure Boot Camp, and I willingly surrender and promise that, for a period of no less than 24 months afterward, I will not directly or indirectly participate in a business that is similar in nature and in the same geographic area (within a radius of 50 miles) of any Adventure Boot Camp. This includes participating in my own business or as a co-owner, director, officer, consultant, independent contractor, employee or agent of another business.
  6. Acknowledges that this Accident Waiver and Release of Liability form will be used by Adventure Boot Camp, in which the undersigned chooses to participate, and that it will govern my actions and responsibilities at during my activities with the Boot Camp.
  7. I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during my Boot Camp training.

By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive physical exercise.  I also acknowledge that I have been informed of the need to obtain a physician's examination and approval prior to beginning this exercise program. In signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including but not limited to abnormal blood pressure, fainting, heart attack or even death.  I also understand that I may stop any training session at anytime.  By signing this document, I assume all risk for my health and well being and any resultant injury or mishap that may affect my well being or health in any way and hold harmless of any responsibility, the instructor, facility or persons involved with the program and testing procedures.
 
The Undersigned agrees that this is the full agreement between the parties, that no representatives of Ventura Adventure Boot Camp or True North Pioneering, Inc., 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.

Please check if you accept these terms. You will be asked to sign acknowledgement at your evaluation.

PART 5: PERFORMANCE PLEDGE
 
In the spirit of harnessing your best effort and optimizing your results from Adventure BootCamp (as stated in the "What you can Expect" statistics), we have established the following personal performance pledges. This agreement is by and between you and yourself. Your greatest results will be achieved by following these edicts. Your choice to break any performance promises is breaking a promise to yourself, moves you away from your stated goals, and WILL result in other than best results. In excessive cases, it will cause other than favorable results such as fat mass gain, body composition increase, or lean mass loss. If you have genuine concern about being able to follow any of these promises, please contact us for additional lifestyle coaching services so we can supplement your program and work together to optimize your efforts and move you toward your performance goals!!
 
You will need to check your understanding to each pledge promise and demonstrate your agreement by signing at the bottom in order to join us in Boot Camp.

Click each of the following:

I agree that I will abstain from [not consume] alcohol during my Boot Camp period.

I agree to abstain from the use of foul language during Boot Camp.

I agree to abstain from eating or speaking the words Twinkie, Donuts, Cookies, potato chips, Brownie, Ho-Ho's, Ding Dong, or Cake during the course of 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 Boot Camp directors.

I will arrive at camp ON TIME. [I will set 4 or more alarms as necessary to ensure.]

(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 Boot Camp, which may be used for promotional purposes and I provide my release for same. 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 my 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. I understand that absences cannot be recouped or made up. Camp credits may not be used towards any other products or services provided by True North Pioneering, Inc.

I understand that I may only attend the class I am registered in

I will follow proper dietary practices as explained by the VABC instructors.

I have read and fully accept the Ventura Adventure Boot Camp Program Policies and Guidelines .

Your signature will be required at the time of your evaluation and you agree to the terms now by clicking the SUBMIT REGISTRATION BUTTON below!
By submitting this form, you are agreeing to all the above!

After submitting your registration you will be redirected for ONLINE PAYMENT.
NOTE: Your registration will be confirmed only after receipt of payment. Space is limited and classes sell out, so to secure your place in camp please submit your payment immediately.

If paying by check, please make checks payable to True North Fitness, and mail it to:

Ventura County Adventure Boot Camp
6019-D Olivas Park Drive
Ventura, CA 93001

 
 
 

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