New Customer Registration Form

CHALLENGE

Pre-registration form
Full Name*

First NameLast Name
Contact Number*
Format: (000) 000-0000.
Date

MonthDayYear
Date
E-mail
example@example.com
Referred by *

First NameLast Name
On a scale of 1-3, 1 being unfit, where would you rate your fitness level*
Personalized Meal Plan
Individual Plan: R400Couples Plan: R700 per couple (Enjoy a discounted rate when you sign up together!)
NoYes
If yes, Please Specify
COMPULSORY!

This is a 4 week bootcamp challenge and one of the requirements is for you complete a wellness assessment with your coaches.This MUST be done within the first two weeks of the new bootcamp challenge.

Please include 5 names and cellphone numbers of people you think would be interested in joining our bootcamp challenge.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
R170 fee

Anyone under the age of 18 muat have a waiver form signed by a parent or legal guardian. No children under 12 can participate in workouts.

Please consult your doctor if you have any injuries, as we do not want to be held liable for further injuries.
Emergency name and number

First NameContact number
Should be Empty:

CHALLENGE

Personalized Meal Plan