HEALTH HISTORY FORM - PERSONAL INFO

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MORNING  BOOT CAMP 6 am (Mon. Wen. Fri.)

You may enlist after a course has started and can make up any of your missed days.

WAIVER OF LIABILITY As a participant in this program, you represent that you have no congenital physical or mental health problems that will preclude participation in the services provided by the Personal Power training Fitness Boot Camp specifically, you represent that you have no underlying cardiovascular, neurological, orthopedic or any other illness that will preclude participation in any training program. You assume risk with any/all of the fitness programs specified under this agreement provided by PPT. You also acknowledge that boot camps, cardiovascular exercise, martial arts, kick boxing, running, resistance training, timed events, obstacle courses, and any other related sports activities 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. You also understand the risks of participating in these types of events/activities, you are healthy enough to participate, and you have a regular medical physician that you can contact regarding any medical problems that you might develop. You expressly waive, release, discharge and agree not to sue (from any liability of death, disability, personal injury, or action of any kind) PPT, The Personal Power Training, Scott White, her assistants/instructors or any other guest involved with PPT. NON-COMPETE/ NON DIS-CLOSURE As a member of The Personal Power training Fitness Boot Camp, you will be receiving privileged information intended for YOUR education, YOUR physical improvements and YOUR mental focus only. The PPT program and any product associated or developed by Personal Power Training, or Scott White, may NOT be reproduced, stored in a retrieval system, or transmitted, in any form or by means electronic, mechanical, photocopying, and recording. You also testify that you do not work in a competitive or similar fitness or health field and have no immediate intentions or later intentions of developing a similar type of fitness program. Should you decide to disclose/use this information, you agree that you will be held liable for attorney fees. MISSED DAYS/ ABSENSES You may make up any missed days during your current course or the very next 4-week course. Any unused days past the 30-day/4 week limit will be forfeited. You may NOT transfer your missed days to family members/friends, etc. You may not pro-rate any monthly fees because of missed days. Payments are still due in full no matter how many days you miss or are able to make up. PHOTO/ VIDEO RELEASE Action photos and videos may be taken throughout the program for purposes of promoting PPT and Scott White. These photos may be printed in newspapers, magazines, websites, commercials and other forms of advertising. You agree that these photos and videos are the property of PPT and may be used at any time for promotional purposes. We will ask for your permission first before printing any individual FREEZING If signed up for 6 months to a year, you may freeze this Agreement for up to ONE MONTH, for any reason; by giving at least (7) seven days notice via email or phone call to the Commander at swhite@personalpowertraining.net or 480-628-1607. You may only freeze (1) one month at a time. Those enlisted for only 1 course/4 weeks may NOT freeze this agreement. You may however make up your missed days at a later time. After one month of freezing, your account will become due and active again whether you attend or not. LATE CHARGES / FEE FOR RETURNED OR INSUFFICIENT FUNDS If PPT receives a payment more than 7 days after the due date, you will be charged $20.00. If any payment under this agreement is returned, you will be charged a $20.00 returned item fee for checks and $20.00 for any credit card payments that are not honored. TRANSFERS/ CHANGES Once enlisted into a course, you must complete that entire agreement/course before switching to a different course length. (i.e. You must complete one full boot camp course (4 weeks) at the introductory rate before signing up/receiving the one-year rate). You may NOT transfer your boot camp of any length to another person, friend or associate. CANCELLATION/REFUNDS If you have to cancel this agreement for ANY reason (sick, injury, family emergency, work change etc.) and are only signed up for one course WINING RULES If you have won a boot camp via a raffle or other prize, a materials/administration fee of $60.00 is required. If you have won a boot camp via an auction, you must present your wining certificate number and the hard copy upon registration to avoid any additional fees. No matter how you have won your boot camp, there are no transfers or refunds. PAYING BY CREDIT CARD I understand that my credit card statement will read: Personal Trainer Scott White. If for some reason my CC does not work, I will give a new card number as soon as I am notified to avoid any late charges. I understand that my card will be automatically charged on the due dates I agree to at the health screening. PAYING BY CHECK I understand that I am to make the check out to Scott White / Personal Power training. I will ensure that my check is hand delivered or mailed to the address below ON or BEFORE each payment is due. I also understand that if I do not pay each installment within (7) seven days of due date listed on my statement, I agree to pay a late fee of $20.00 LEGAL REMEDIES I also understand that if the PPT needs to enforce the payment terms of this agreement by and through any legal remedies available; that besides the amount that I owe to the PPT, I will be responsible for any and all legal fees incurred by the PPT to enforce my financial obligations that I have agreed to. PPT reserves the right to refuse service to anyone if they are not at a level of fitness appropriate to participate in the majority of activities and exercises. The same holds true if someone works or has worked in a competitive field with PPT.

By submitting this form, you understand and agree that this contract is electronically signed

and as such, you are waiving your right to a physical signature and agreeing

that this order form is enforceable without your physical signature. 

I agree to the terms listed

I disagree.