RM_StatsFirst Name *Surname *Date of Birth *Please provide your date of birthMobile Number *Please provide your mobile numberEmail *Password *Password must be at least 7 characters long.Enter password again *Password must be at least 7 characters long.Emergency Contact PersonEmergency Mobile Number *Relationship to you *What is Your Occupation? *Health & Medical HistoryPlease read through the questions carefully and answer each one with Yes or No Do you smoke? *Select an optionYesNoAre you currently pregnant? *Select an optionYesNoIs there a family history of stroke or heart disease ? *Select an optionYesNoIf yes, please specifyDo you struggle with high blood pressure? *Select an optionYesNoDo you struggle with high cholesterol? *Select an optionYesNoAre you currently taking any prescribed medications for a chronic medical condition? *Select an optionYesNoIf yes, please specifyDo you have any current or pre-existing injuries that may restrict your training that your trainer should be aware of? *Select an optionYesNoIf yes, please specifyHave you had any major surgeries in the past 12 months? *Select an optionYesNoIf yes, please specifyFitness QuestionsOn a scale of 1-10 (10 being the fittest), how would you rate your overall fitness level? * 1 2 3 4 5 6 7 8 9 10 What are your goals or main reasons for participating in this fitness programme? Tick all those applicable * Get Fit Lose weight Build strength/muscle tone Improve my health Be part of a fitness community with other like-minded women OtherWhere did you hear about me? *Select an optionGoogleFacebookWord of MouthFrom a friendI'm a previous camperMaryvale NewsletterI'm a Maryvale Staff MemberWanderers WebsiteOtherTrue and correctI AgreeI confirm that I have answered all the questions above as honestly as possible and that I have disclosed the correct information to the best of my knowledge and do realize that this information will be kept confidential by my Fitness Trainer and is only required to ensure my safety during exerciseReady to get going!Boot Camp Winter Fitness Challenge - 40 Sessions - R1,400 (Payable over 2 camps) May Camp 5 - 12 Sessions - R630 May Camp 5 - Unlimited Sessions - R700 Please select your class time & locationSelect an option05h30 The Wanderers club - Illovo17h45 Maryvale College Primary - OrchardsPayment Policy Terms & Conditions *I AgreePAYMENT POLICY • All fees are payable in advance via EFT Bank Details Michelle Rozowsky First National Bank Account No. 6208 668 6345 250655 Reference: Please Use BC – Your Name Kindly email POP to michelle@bootcamponthemove.co.za • Sessions not attended within a 4 week camp may unfortunately not be carried forward to the following camp • Switching between morning and evening time-slots is permitted for the unlimited session option. Please just let your trainer know beforehand. A once off fee of R150 is required for an access card to train at The Wanderers Club to be added to your camp fee • In the event that you should fall ill or injured during a camp, a pro-rate credit/ refund will be considered on submission of a medical certificate from the relevant health or medical practitioner. No other refunds will be considered unless under exceptional circumstancesPayment PolicyWaiver Terms & Conditions *I AgreeBy entering this website or purchasing or using our blog, e-mails, programs, services, and/or products, you are agreeing to accept all parts of this disclaimer. Thus, if you do not agree to the disclaimer below, STOP now. Michelle Rozowsky strongly recommends that you consult with your physician before beginning any exercise program. You should be in good physical condition and be able to participate. Michelle Rozowsky is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific exercise on a medical condition. You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Michelle Rozowsky from any and all claims or causes of action, known or unknown, arising of Michelle Rozowsky. The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice. Michelle Rozowsky is not responsible or liable for any advice, course of treatment, diagnosis or any other information, services or products that you obtain through this site. You are encouraged to consult with your doctor with regard to this information contained on or through this website. After reading articles, watching videos or reading other content from this website, you are encouraged to review the information carefully with your professional healthcare provider.T's & C'sPrivacy PolicyI acceptYour privacy is very important to me and I will always act to protect your personal information. Information collected through the registration process is completely between you and me to ensure your safety when signing up for one of my fitness packages. Personal information collected includes your name, contact details, date of birth, emergency contact details as well as information about your medical, health and fitness history. Information collected will always be private and will never be shared with a third party without your consentT's & C'sFree Trial ClassNever done Group Fitness with Boot Camp On The Move before? Why not come and try a Free Trial class before committing to a package so you can see what it is all about?Select an optionBoot Camp - 05h30 The Wanderers ClubBoot Camp - 17h45 Maryvale College Primary Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
