Indy Anventure Boot Camp: Registration

There are 3 Options for You to Choose from to Register.

1. Print the form to pay by check. Make the check payable to Fit Wright, Inc. and mail to:
1735 Brassica Lane Indianapolis, IN 46217
Please right click and save this link for the printable form.

2. Call 317-658-6731 to register by Phone.

3. Pay by Credit Card through the online form below.

Full Name:
Address:
City:
State:
Zip:
Profession:
Country:
Date of Birth:
Phone Home:
Phone Cell:
Email Address:

I rate my current fitness level as a (1-10), 10 being highly fit:

Name of Emergency Contact & Phone #

Name of Camp (Check the Calendar for more info):

Program Type:

Have you participated in Indy Adventure Boot Camp before?

How did you hear about Indy Adventure Boot Camp?

For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time if you are registering online.
*We accept Visa, Mastercard, and Debit cards Only *

Credit Card Type:

Credit Card Number:

Exp. Date:

Name on Credit Card:

CVC Code**:

**In the signature box on the back of your card, you should see a 16 digit credit card number followed by a special 3 digit code. This 3 digit code is your security code.

1 Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?	Yes No
2 Do you take any prescribed medication on a permanent or semi-permanent basis?	Yes No
3 Do you have a seizure disorder (epilepsy)?	Yes No
4 Do you have diabetes; Type I (IDDM) or Type II (NIDM)?	Yes No
5 Have you ever been found to be anemic (low blood count)?	Yes No
6 Do you have High Blood Pressure (hypertension)?	Yes No
7 Do you have or have you ever had Heart Disease?	Yes No
8 Do you have or have you ever had Lung Disease?	Yes No
9 Do you have or have you ever had Kidney Disease?	Yes No
10 Do you have or have you ever had Liver Disease?	Yes No
11 Do you have or have you ever had asthma?	Yes No
12 Do you have or have you ever had severe neck injury?	Yes No
13 Have you ever had been knocked out?	Yes No
14 Have you had a broken bone or fracture in the past 2 years?	Yes No
15 Do you wear glasses or contact lenses?	Yes No
16 Have you ever injured your back?	Yes No
17 Have you had knee pain in the past 2 years that has disabled you for longer than a week?	Yes No
18 Do you have other physical conditions, which cause pain?	Yes No
19 Have you had any surgical procedures?	Yes No
20 Have ever had your body fat tested?	Yes No
21 Are you training for a specific event?	Yes No

If you are unsure about the definition of any terms in this form, please call us to clarify. Do not assume.

RELEASE This release is entered into between the undersigned and Indy Adventure Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the Franklin Township. The purpose of II Indy 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 Jason or Jessica Wright 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 that Indy Adventure Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Indy 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 Indy 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 Indy Adventure 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. By checking this box below, you agree to all of the terms mentioned above.

Do you attest that all of the information you have supplied is accurate and complete?
Do you attest that you have read the Release information provided above and comply?

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