Foothills CrossFit Registration

CrossFit:

Secure Foothills CrossFit Registration Form

Use this online form if you are paying by credit card only.
If you want to mail in/fax/bring in person your registration form, click on the form icons below to download:

NOTE: We cannot guarantee your space will be reserved if you do not supply us with payment information on this form. CLICK HERE to ready our Privacy Policy

Email Address:
Name:
Street Address:
City, State:
Zip Code:
Date of Birth, Please include Year:
Best Contact Phone Number w/area code:
I rate my current fitness level as: (Ten being high)
Please tell us how you heard about us:
CrossFit Investment:
This is my first CrossFit:	Yes No
If you answered "no" - when was the last CrossFit you attended?
Emergency Contact Name and Phone #:
Note: If paying by check, do not use this online form. Please download the mail-in form above. For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time to process your registration. Please note: your credit card statement will show a charge to "Front Range Boot Camp" our sister program.
I will be paying by:	Mastercard Visa Discover
Credit Card Number:
Exp. Date:
Name as it appears on Credit Card:
CVC Code* on back of Credit Card:
*Billing address of Credit Card if different than above address:*
Visa & Mastercard In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a 3-digit code. This is your CVC. MEDICAL HISTORY:* If you are a returning CrossFitter and have no medical changes, the section below does not need to be completed. ALL CrossFitters, Please check the Terms and Conditions Box before you Submit - Thank You, I look forward to seeing you in class!
1. Are you allergic to any medication? Please list:
2. Do you take any prescribed medication (permanent/semi-permanent)? Please list:
3. Do you have a seizure disorder (epilepsy)?	Yes No
4. Do you have diabetes?	Yes No
If yes to above, please list medications:
5. Do you have asthma?	Yes No
6. Do you have High Blood Pressure (hypertension)?	Yes No
If yes to above, please list medications:
7. Do you have or have you ever had any of the following diseases? (check all that apply)	Heart Disease Lung Disease Liver Disease Kidney Disease
8. Have you ever been found to be anemic (low blood count)?	Yes No
9. Have you ever had a severe neck injury? If Yes, please describe:
10. Have you ever been knocked out? Please describe:
11. Do you wear contact lenses?	Yes No
12. Have you had a broken bone or fracture in the past 2 years? Please describe:
13. Have you ever injured your back?
14. Do you have back pain?	Never Seldom Occasionally Frequently with exercise or heavy lifting
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? Please describe:
16. Do you have other physical conditions which cause you pain? Please describe:
17. Please detail any surgical procedures:
18. Please describe your GOALS for the next 3-months and WHY?
RELEASE: This release is entered into between the undersigned and Foothills CrossFit / Front Range Boot Camp, L.L.C. its officers, affiliates, trainers and executors in addition to the City of Arvada, Jefferson County Public Schools, Westwoods Park, and all other private and public locations for camps including Jefferson County. The purpose of Foothills CrossFit / Front Range Boot Camp, L.L.C. 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 Robyn Morrisette 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 Robyn Morrisette does not guarantee neither good nor bad will occur nor guarantees the training advice given by Foothills CrossFit / Front Range Boot Camp, L.L.C. 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. Videography and photography may be taken at various camp locations which may appear on TV, web video, print or any other digital format. When possible, the camp particpants will be told in advance of the days in which any photography or videography will be done. "Before & after" photos will not be used for any promotional purposes unless written authorization is granted. 5. 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 inherent dangers of the natural elements, 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 and Foothills CrossFit / Front Range Boot Camp, L.L.C. 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 Robyn Morrisette, 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. 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 Foothills CrossFit/ Front Range Boot Camp, L.L.C. I will remember to set my alarm and be at class on time.
Yes, I have read and agree to all terms and conditions.