Body Buster Fitness Boot Camp - Registration Form

All prices listed are in Canadian dollars.

Body Buster memberships are nontransferable.

I understand that my absent days are not carried forward to another Boot Camp session but I may make them up during the same session but at an alternate time. Limited to two makeup classes per session based on Body Buster approval.

I understand that there may be photos / video footage taken that may be used for marketing / advertising.

I understand that there are no refunds but I may carry over my contract with a note from a physician stating if I am no longer able to continue the Body Buster Fitness Boot Camp program with the notion that I would return when the physician sees appropriate.

I understand that all activities involved with the Body Buster Fitness Boot Camp program may be an extreme challenge to my physical and mental abilities. I hereby certify that I am fit to participate in any and all such activities and that such determination has been made by a qualified medical professional.

I understand that activities involved in the fitness program carry with them the potential of harm to myself, my property, loss or damage to my possessions, bodily injury and death. I hereby certify that I understand and accept all risks associated with my participation in Body Buster Fitness Boot Camp and agree to hold harmless it’s management, staff, or associated person(s) and/or entities from and against any and all liability for any harm to myself or my property that may arise from my participation in this program.

I understand that I must be aware of my physical conditions/limits and that there are risks associated with fitness training activities. Also, I understand that I am encouraged to get a regular medical examination prior to participating in the Fitness Boot Camp program.

The schedule, location, or content of workouts may be changed on occasion due to circumstances beyond the control of Body Buster Fitness.

Body Buster Fitness Boot Camp membership payments are non-refundable.

I understand that in order for me to take advantage of reduced session pricing offered by Body Buster Inc., for multi-session packages of one of 3, 6 or 10 consecutive session, I must commit to pay Body Buster Inc. by monthly installment payments for the multi-session package I select.

I agree to have Body Buster Inc. charge may credit card on a consecutive monthly basis starting with the day I sign up and continuing for each and every month that follows up to a total number monthly charges to my credit card equal to the number of sessions set out in may package. (For example, if I sign up for 3 consecutive sessions Body Buster Inc. shall charge my credit card the lower session pricing on the day I sign up and on the same day in the next two months).

I understand that the monthly charge to my credit card is determined by the day of sign up and does not correspond to the actual starting dates for the session for which I have signed on.

I certify that I have read and fully understand the waiver, liability,
and policies and fully agree to abide by the conditions and terms stated above.

Full Name
Mailing Address
City		Postal Code
Home Phone		Work Phone
Cell Phone		Date Of Birth
E-Mail Address
I am a:	New Member Returning Member
Referral Number:

Nov 24 - Dec 19, 2008	Jan 12 - Feb 6, 2009	Feb 16 - Mar 13, 2009
Mar 23 - Apr 24, 2009	May 4 - May 29, 2009	Jun 8 - Jul 3, 2009
Jul 13 - Aug 14, 2009	Custom Program - Nov 24 Program Only

Etobicoke South - Two Days Per Week Franklin Horner Community Centre 432 Horner Avenue, Etobicoke	6:00AM - Mon, Wed 6:00AM - Mon, Fri 6:00AM - Wed, Fri 6:30PM - Mon, Wed 6:30PM - Mon, Fri 6:30PM - Wed, Fri 7:30PM - Mon, Wed 7:30PM - Mon + 6:30 - Fri 7:30PM - Wed + 6:30 - Fri
Etobicoke South - Three Days Per Week	6:00AM - Mon, Wed, Fri 6:30PM - Mon, Wed, Fri 7:30PM - Mon, Wed + 6:30PM Fri

Four (4) Week Session Memberships	Two (2) Days Per Week For Four (4) Weeks = Eight (8) classes per session
One (1) Session Membership	$155 + GST ($7.75) = $162.75 per session
Three (3) Consecutive Sessions Membership (!!! See the note below !!!)	$140 + GST ($7.00) = $147.00 per session ($45 total savings!)
Six (6) Consecutive Sessions Membership (!!! See the note below !!!)	$130 + GST ($6.50) = $136.50 per session ($150 total savings!!)
FULL YEAR PROGRAM Ten (10) Consecutive Sessions Membership (!!! See the note below !!!)	$120 + GST ($6.00) = $126.00 per session ($350 total savings!!!)
!!! NOTE !!! When registering for three or more consecutive sessions, your first session will be billed immediately. You will then be billed automatically monthly. You're "Recurring Billing" will be for 2 recurring charges (for a 3 session membership), 5 recurring charges (for a 6 session membership), or 9 recurring charges (for a 10 session membership). Recurring billing can only be done on credit card.

Four (4) Week Session Memberships	Three (3) Days Per Week for Four (4) Weeks = 12 classes per session
One (1) Session Membership	$215 + GST ($10.75) = $225.75 per session
Three (3) Consecutive Sessions Membership (!!! See the note below !!!)	$195 + GST ($9.75) = $204.75 per session ($60 total savings!)
Six (6) Consecutive Sessions Membership (!!! See the note below !!!)	$180 + GST ($9.00) = $189.00 per session ($210 total savings!!)
FULL YEAR PROGRAM Ten (10) Consecutive Sessions Membership (!!! See the note below !!!)	$170 + GST ($8.50) = $178.50 per session ($450 total savings!!!)
!!! NOTE !!! When registering for three or more consecutive sessions, your first session will be billed immediately. You will then be billed automatically monthly. You're "Recurring Billing" will be for 2 recurring charges (for a 3 session membership), 5 recurring charges (for a 6 session membership), or 9 recurring charges (for a 10 session membership). Recurring billing can only be done on credit card.

Custom 2 Day Membership	Custom 3 Day Membership	Custom 4 Day Membership	Custom 5 Day Membership
$175 + GST ($8.75) = $183.75	$235 + GST ($11.75) = $246.75	$260 + GST ($13.00) = $273.00	$280 + GST ($14.00) = $294.00

When choosing your custom program, you MUST take classes from two (2) or more locations. You CANNOT take all your custom program classes in one location*. (Exception: High Park - four or five class custom programs may be taken all in High Park)
	Monday	Tuesday	Wednesday	Thursday	Friday
Etobicoke Central	9:30AM	6:00AM 6:15PM 6:30PM 7:30PM	9:30AM	6:00AM 6:15PM 6:30PM 7:30PM	6:00AM
Etobicoke South	6:00AM 6:30PM 7:30PM		6:00AM 6:30PM 7:30PM		6:00AM 6:30PM
High Park / Bloor West	6:30PM 7:30PM		6:30PM 7:30PM		6:30PM
Custom Programs are designed to allow members the flexibility of attending classes on a regular basis at 2 or more locations of their choice.

Equipment needed: Yoga Mat, Exercise Ball, and Hand Weights. (5lbs weights for women and 8lbs weights for men is suggested). These items may be purchased from Body Buster Fitness, and can be picked up at your first class. All other equipment will be supplied by Body Buster Fitness during class.
Item	Qty
Hand Weights - 5 lbs (women) - $10.00 each	2 x $7.50 = $15.00 + tax
Hand Weights - 8 lbs (men) - $12.50 each	2 x $10.00 = $20.00 + tax
Exercise Ball - $22.50	$22.50 + tax
Ball Pump - $4	$4.00 + tax
Exercise Mat - $22.50	$22.50 + tax
Mesh Carry Bag for Exercise Mat - $10	$10.00 + tax
Boot Camp Bundle - Save 16.5%! Includes Exercise Mat, Hand Weights, and Exercise Ball	5lbs Bundle - $50.00 + tax 8lbs Bundle - $55.00 + tax
*A receipt will be sent to your email address. You may pick up any equipment ordered at your first fitness boot camp class.

Women's Shirt	Men's Shirt
What size do you prefer?
Size availability depends on what we have in stock at the current time. We will do our best to accommodate your size request.

Name Of Physician		Phone Number

Emergency Contact
Name		Relationship
Primary Phone		Secondary Phone

How did you hear of Body Buster Fitness' BOOT CAMP classes? Note: please be specific by providing name of company or friend. i.e. Google, The SUN, Jane Smith, Bob Dole, etc.
What are your fitness goals during BOOT CAMP?
Have you ever taken a BOOT CAMP CLASS before?	Yes	No
If yes, please explain:
Are you currently involved in any physical activity?	Yes	No
If yes, please explain:
How would you rate your current fitness level from 1 (sedentary) to 10 (very fit)?

Do you have any past or present injuries?	Yes	No
If yes, please explain:
Do you know of any reason why you should NOT do physical activity?	Yes	No
If yes, please explain:
Do you have a heart condition or other condition that may cause challenges while doing physical fitness activities?	Yes	No
If yes, please explain:
Please note that it is a good idea to consult your physician before starting any new fitness program. Be sure to pace yourself in regards to your current fitness level and remember to have fun! It is also a good idea to ensure that you are getting an adequate amount of water especially when adding fitness into your daily lifestyle. Please note that you will be asked to sign a waiver form at the first day of class.

Do you have any of the following:
Anemia	Yes No	Hypertension	Yes No
Asthma	Yes No	Diabetes	Yes No
Epilepsy	Yes No	Back Pain	Yes No
Neck Pain	Yes No	Arthritis	Yes No
Cancer	Yes No	Joint Pain	Yes No
Recent Surgeries	Yes No
If you answered yes to any of the above, please explain:
Please list any medications you are currently taking: