Kettlebell Training Colorado, Extreme Fitness Training, Alternative Fitness Colorado, Outdoor Fitness Colorado

CIA CrossFit Kettlebell Fitness Training for Elite Athletes, Fitness for Women, Fitness for Men, Serious Training, Life Training, Obsessive Training

- Forging Elite Fitness –
Aurora & Centennial, Colorado

CIA CrossFit Kettlebell Boot Camp - 9:00 a.m.
Secure Registration Form:

SSL Certificates

Use this online form if you are paying by credit card only.
If you want to mail in/fax in your form, click on the appropriate form to download:

NOTE: We cannot guarantee your space will be reserved if you do not supply us with payment information on this form. CLICK HERE to ready our Privacy Policy

Email Address:
Name:
Street Address:
City:
State:
Zip:
Profession:
Date of Birth:
Best number to reach you at (i.e. cell phone):
I rate my current fitness level as a (1-10), Ten being high:
Experience Level with Kettlebells:	Beginner Intermediate Advanced
I was referred by:
Class Time Desired:	9:00-10:00 a.m.
Program I am signing up for:
Start Date of Program Registering for:
Promotion Code if available:
This is my first time with CIA:	Yes No
If you answered "no" - when was the last session date you attended?
Emergency Contact and phone number:
Note: If paying by check, do not use this online form. Please download the mail-in form above. For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time to process your registration.
I will be paying by:	Mastercard Visa AMEX Discover
*Credit Card Number:*
*Exp. Date:*
*Name as it appears on Credit Card:*
**CVC Code on back of Credit Card:***
*Billing address of Credit Card if different than above address:*
Visa & Mastercard In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a 3-digit code. This is your CVC. American Express* On the front of your card next to your main credit card number look for a 4 digit code. This is your Card Security Code. MEDICAL HISTORY: If you are a returning trainee and have no medical changes or if you have trained in one of our other camps, the section below does not need to be completed. ALL Campers, Please check the Terms and Conditions Box before you Submit - Thank You!
1. Are you allergic to any medications, foods, insect bites? Please list:
2. Do you take any prescribed medication (permanent/semi-permanent)? Please list:
3. Do you have a seizure disorder (epilepsy)?	Yes No
4. Do you have diabetes?	Yes No
If yes to above, please list medications:
5. Do you have asthma?	Yes No
6. Do you have High Blood Pressure (hypertension)?	Yes No
7. Do you have or have you ever had any of the following diseases? (Check all that apply)	Heart Disease Lung Disease Kidney Disease Liver Disease
8. Have you ever been found to be anemic (low blood count)?	Yes No
9. Have you ever had a severe neck injury? If yes, please describe:
10. Have you ever been knocked out? If yes, please describe:
11. Do you wear glasses or contact lenses?	Yes No
12. Have you had a broken bone or fracture in the past 2 years? If yes, please describe:
13. Have you ever injured your back? If yes, please describe:
14. Do you have back pain?	Never Seldom Occasionally Frequently with exercise or heavy lifting
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? Please describe:
16. Do you have any other physical conditions that cause you pain? Please describe:
17. Please detail any surgical procedures:
18. Please describe your GOALS for the next 3-months and WHY?
19. What is your T-shirt Size:
RELEASE: This release is entered into between the undersigned and CIA, L.L.C. its officers, affiliates, trainers and executors in addition to the City of Aurora, Cherry Creek Public Schools, Arapahoe County, Toy Storage, L.L.C. and all other private and public locations for camps. The purpose of CIA, L.L.C. is to provide fitness instruction and coaching for various levels of athletes/individuals. The undersigned hereby acknowledge that the following was explained to me and/or agree to the following: 1. Acknowledges that Agent Meier is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. 2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Agent Meier does not guarantee neither good nor bad will occur nor guarantees the training advice given by CIA, L.L.C. will produce good nor bad results. 3. Acknowledges that the undersigned has been told if they feel tired, feel pain or feel out of the ordinary in any way either related to your training, or otherwise, that the undersigned should contact a physician at once. 4. Videography and photography may be taken at various camp locations which may appear on TV, web video, print or any other digital format. When possible, the camp participants will be told in advance of the days in which any photography or videography will be done. "Before & after" photos will not be used for any promotional purposes unless written authorization is granted. 5. Acknowledges that boot camps, kettlebells, sandbags, medicine balls, rings, weight training, obstacle courses, and any other related sports 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. That the undersigned assumes the risks of participating in these types of events/activities including the inherent dangers of the natural elements, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The Undersigned agrees that this is the full agreement between the parties, that Agent Meier, nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion. I agree to show up for trainiing with CIA every day unless it is an excused absence from my doctor or approved by Agent Meier. I understand there is NO REFUND policy, but I can receive a credit (for the unused portion of the camp) towards a future camp if I’m not able to complete the one I originally joined. CIA fees cannot be used towards any other products or services. I understand that photos or video may be taken during the course of my involvement in CIA which may be used for promotional purposes. I understand that my “before and after” photos will not be used for any promotional purposes without my express written consent. I understand that diet and nutrition will effect my fitness goals and performance during boot camp. I will remember to be on time! By checking the box to agree to all terms and conditions, I expressly waive, release, discharge, and relinquish CIA, L.L.C. and Kelli Meier from any and all causes of action, including any liability of death, disability, personal injury, or action of any kind, that may arise out of my participation in CIA, L.L.C. activities or events and/or training for such activities or events.
Yes, I have read and agree to all terms and conditions.