Registration Form

Fitcamp Class Registration

Monday - Thursday @ 7PM
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Referred by
What is your goal?
Emergency Information
Emergency Contact's Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my participation in any and all activities prepared by Vida Wellness during the class time. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Vida Wellness . and all its respective officers, agents, and representatives from any and all liability for injuries to arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury, I hereby waive all claims against Vida Wellness, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
SOCIAL MEDIA RELEASE FORM

I hereby consent to release for possible publication my photo(s) and/or video images taken by any authorized Vida Wellness// Grand Vision Corp representative, or any media representative for news and/or publicity purposes. This may include television, newspaper, magazine article, social media websites, and/or Vida Wellness or GVC publications (newsletters, flyers,
brochures, web pages, etc.). I also agree to allow the publication or broadcast of
my name in connection with any photo(s) and/or video images taken, and I
understand that I will not receive remuneration for my voluntary participation or
future use of any photo(s) and/or images of me. I understand that photos and/or
videos for the media and/or World Wide Web may be used in publications and/or
websites outside of Vida Wellness or GVC control.
This consent remains in effect indefinitely unless notice of revocation of
authorization by consentor is submitted in writing to Vida Wellness and representatives.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Payment Method
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Fitcamp Class Registration