BOOMfit Registration Form

Registration Form
Thank you for your interest in BOOMfit. Please take a moment to complete this form. The information you provide is used to help us to tailor our workouts to the needs of our members.
Name*

First NameLast Name
Email*

Confirmation Emailsomeone@example.com
Phone Number*

Area CodePhone Number
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please choose the service you are signing up for.*

10 week BOOMcamp - $280 (commences Tues 09/02/2021)BOOMfit Online - FREE!
BOOMfit Online memberships are free of charge from February 2021. Please refer to the confirmation email access details. Access to online classes is via Facebook so you will need to have a Facebook account.
By signing up for a BOOMcamp you are committing to a full 10 week programme. If you choose the weekly installments payment option you are agreeing to pay for the full 10 weeks. Please refer to the confirmation email for bank account details to set up automatic payments.
Preferred Payment Option*

Full Payment Up Front ($280)Weekly Installments ($28 per week for 10 weeks)
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
How Did You Hear About BOOMfit?

Facebook adWeb searchWord of mouth/referralPost on public group/pageOther

How motivated are you to exercise regulary?

	1	2	3	4	5

1 is I find it hard to get going, 5 is Can't wait for the next session

Which of these health and fitness goals are important to you?

Become fitterGet strongerLose weightTone upMore energyCross trainingSleep betterManage stressOther
What have you done in the past (sports or recreation)?
What exercise do you enjoy?
If you are pregnant, at a post partum stage, have any injuries or have a medical condition that may impact your ability to safely participate in BOOMfit classes then you should consult with a doctor or other suitably qualified medical professional prior to commencing any fitness programme.
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