July 8, 2015


Bootcamp Connect  

Brief Overview of BC Payment Options:

Pricing Options for each 4 week camp:

    • $229 for Unlimited Workouts (up to 12 )
    • $199 for 9 Workouts

    • $149 for 6 workouts
    • $30 for 1 workout
  • SPECIAL OFFER For Santa Monica  Classes: 1 Trial Week of classes (M-W-F) for ONLY $20

*All packages are to be used throughout a four week period. Classes are NOT carried over to the next camp.

**SPECIAL OFFER: if after your week trial you decide Bootcamp Connect isn’t for you; you walk away. However, if you decide you LOVE IT (and I know you will), your $20 will be put toward whatever package you want to purchase for the remainder of camp.

You now have 2 options:
A. You can print this form and send it in with payment by mail
B. Register Online
Fill out the online form below to register via internet.
Click on Submit to go to the payment page.
Payment Page: Pay via Paypal. Choose your class and finish your online registration (A PayPal account is not required to pay via PayPal) OR pay with Venmo…sending money to @AdamMichael-Brewer

NOTE: Spaces fill quickly for this unique experience.
We cannot guarantee your space until we have received payment.

If paying by check, please bring it to your first session & make check out to:
Adam M. Brewer
Phone: (310) 383-2828

Camp Options

Select Camp Date:

Select Camp Frequency:

Select Camp Time:

Select Camp Payment Type:

Personal Information

Self Assessment & Additional Information

I rate my current fitness level as:

Is this your first Bootcamp Connect Camp:

When was the last Camp you attended:

My Main goal is:

I was referred by (Name of person, website, etc):

How did you hear about us?

Name of Emergency Contact:

Emergency Phone Number:

Medical History

Are you allergic to any medication? List medications:

Do you take any prescribed medication? List medications:

Do you suffer from epilepsy? List medications:

Are you anemic? List medications:

Do you have Diabetes? List medications:

Do you have High Blood Pressure? List medications:

Do you wear glasses or contact lenses?

Do you have Asthma?

Do you have Heart Disease? List medications:

Do you have Lung Disease? List medications:

Do you have Kidney Disease? List medications:

Do you have Liver Disease? List medications:

Have you ever had a severe neck injury? Describe:

Have you ever been knocked out? Describe:

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

Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:

Have you ever injured your back? Describe:

Describe any current pain you may be experiencing: Describe:

Do you have other physical conditions which cause pain? Describe:

Have you had any surgical procedures: Describe:

What are your goals for the next three months? Describe:

Have you had your body fat tested? Describe testing and results:

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

I agree to all Terms and Conditions: