Registration for Camp

Athlete Information:
Athlete's Last Name: * required	First Name:
Grade Level:
School Selection:
Date of Birth:
Email Address:
T-shirt size: (Adult sizes)
Camp date you are registering for:	June 15
Please select a group.	8:00am - 10:00am - Junior High Only 10:15 am - 11:45 am- Middle School Only
Please select payment option based on your group and how many weeks you plan on attending.	Price selection for jr. high session: 2 hr. session 6 weeks ($200 - jr. high group) 5 weeks ($170 - Jr. high group) Other Price selection for middle school camp: 1 hr. 30 min. 6 weeks ($150 - middle school group) 5 weeks ($125 - middle school group) Other
Emergency Contact Name and Number:	Your info
What is your main goal?	Your goals...
What location are you registering to attend?	PJHS
Parent Contact information:
Parent/Guardian's Name:	* required
Mailing address:
Cell Phone:
Best way to contact you:
Medicial History and Release Form:
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
2. Do you take any prescribed medication on a permanent or semi-permanent basis?	Yes No
3. Do you have a seizure disorder (epilepsy)?	Yes No
4. Do you have diabetes; Type I (IDDM) or Type II (NIDM)?	Yes No
5. Have you ever been found to be anemic (low blood count)?	Yes No
6. Do you have High Blood Pressure (hypertension)?	Yes No
7. Do you have or have you ever had Heart Disease?	Yes No
8. Do you have or have you ever had Lung Disease?	Yes No
9. Do you have or have you ever had Kidney Disease?	Yes No
10. Do you have or have you ever had Liver Disease?	Yes No
11. Do you have or have you ever had asthma?	Yes No
12. Do you have or have you ever had severe neck injury?	Yes No
13. Have you ever been knocked out?	Yes No
14. Have you had a broken bone or fracture in the past 2 years?	Yes No
15. Do you wear glasses or contact lenses?	Yes No
16. Have you ever injured your back?	Yes No
17. Do you have back pain?	Yes No
18. If yes, select the best answer:
19. Do you have other physical conditions, which cause pain? Please explain.
20. Have you had any surgical procedures? Please, explain.
21. Have you had knee pain in the past 2 years that has disabled you for longer than a week?	Yes No
22. Are you training for a specific event/sport?	(Holding down the "CTRL" button will allow you to make multiple selections.)
23. What are your goals for this camp?
23. Additional Comments may be posted here.
RELEASE This release is entered into between the undersigned and Phlex Fitness, its officers, subsidiaries, affiliates, and executors. The purpose of the Phlex Fitness' Speed and Strength Camp program 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 Vince Garcia and the trainers working for Phlex Fitness are not physicians and are 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 Phlex Fitness and its trainers do not guarantee neither good nor bad will occur nor guarantees the training advice given by these trainers, 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. Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, kung-fu, 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 elements of a natural environment, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind Phlex Fitness, Vince Garcia, the employees of Phlex Fitness, Pearland ISD, and the City of Pearland for the undersigned participating in said sporting events and/or training for said sporting events. The Undersigned agrees that this is the full agreement between the parties, that no representative of Phlex Fitness or Vince Garcia 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. Yes, by checking this box I agree to the terms above. (A signed copy will be required.)
PERFORMANCE PLEDGE In the spirit of harnessing your best effort and providing optimum results from your Strength & Speed Camp experience, we have established the following policies to which you will need to adhere. I agree not to use foul language during the strength & speed summer camp. I agree to show up for the strength & speed summer camp every day unless it is an excused absence from my doctor or pre-approved with the camp directors. I agree to outwork my opponents to better my team. I will arrive at camp ON TIME. (Any violation of the above statements will* result in twenty push-ups per occurrence.)* I understand that photos or video may be taken during the course of my involvement in the Strength and Speed Camp, which may be used for promotional purposes. I understand that my "before & after" photos will not be used for any promotional purposes unless I give written authorization. I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if, for reasons beyond my control, I am not able to complete the one I originally joined. Camp fees cannot be used towards any other products or services provided by Phlex Fitness. Yes, by checking this box I agree to the terms above.
PAYMENT: Space is limited. To reserve your spot send in payment immediately.	Paying online with credit card (After submitting this form, return to Payment tab to pay.) Mailing in Check (Make check payable to Vince Garcia) (New: receive a 10% discount if you pay with cash or check)