Pre-camp Evaluation

Oakland Adventure Boot Camp Registration

Option A
If paying by check, please make check out to:
Oakland Adventure Boot Camp
1690 Arbutus Drive
Walnut Creek, CA 94595
Email: oaklandbootcamp@mac.com
Phone: (925) 285-5869

Option B
If registering online
Fill out the online form below to register via internet.
Click on Submit to go to the payment page.
Payment Page: Pay via PayPal using a credit card or by transferring funds.
Choose your class and finish your online registration.
A PayPal account is not required to pay via PayPal.
*Transaction fee applied when using a credit card.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

  • If you choose option A, Print this page and mail it in with payment.
  • If you choose option B: Fill out the form below and Click on SUBMIT.

    Please note: All fields are required.

    Camp and Payment Information

    What camp are you joining?:

    Choose your camp time:

    Choose your camp frequency and cost:

    Form of payment:

    Personal Information

    Name:

    Email:

    Phone Number:

    Address:

    City:

    Zip:

    Profession:

    Date of Birth:

    Self Assessment & Additional Information

    I rate my current fitness level as: (1-10):

    Is this your first adventure boot camp:

    Last Camp attended:

    My Main goal is:

    I was referred by:

    How did you hear about us?

    Name of Emergency Contact:

    Emergency Phone Number:

    Medical History

    Enter N/A for any section which is Not Applicable for you.

    Are you allergic to any medication? List medications:

    Do you take any prescribed medication? List medications:

    Do you suffer from epilepsy? List medications:

    Are you anemic? List medications:

    Do you have Diabetes? List medications:

    Do you have High Blood Pressure? List medications:

    Do you wear glasses or contact lenses?

    Do you have Asthma?

    Do you have Heart Disease? List medications:

    Do you have Lung Disease? List medications:

    Do you have Kidney Disease? List medications:

    Do you have Liver Disease? List medications:

    Have you ever had a severe neck injury? Describe:

    Have you ever been knocked out? Describe:

    Have you had a broken bone or fracture in the past 2 years? Describe:

    Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:

    Have you ever injured your back? Describe:

    Describe any current pain you may be experiencing: Describe:

    Do you have other physical conditions which cause pain? Describe:

    Have you had any surgical procedures: Describe:

    What are your goals for the next three months? Describe:

    Have you had your body fat tested? Describe testing and results:

    Are you training for a specific event? If yes, explain:

    I agree to all Terms and Conditions

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