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Benefits of Boot Camp

Secure Mile High Boot Camp 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:
Full Name:
Street Address:
City:
State:
Zip Code:
Date of Birth, Please include Year:
Profession:
Best Contact Phone Number w/area code (i.e. cell phone):
I rate my current fitness level as: (Ten being high)
Please tell us how you heard about us:
Camp Date registering for:
Special Camp Code: (if you have a special camp code your registration will be processed accordingly.) You may also use this box for special information.
Camp Days per week:	* PLUS $10 Processing Fee
Camp Time:	5:30 - 6:30 a.m. - CIA Training Headquarters
	*For other class times... Click Here*
This is my first camp:	Yes No
If you answered "no" - when was the last camp you attended?
Emergency Contact Name and Phone #:
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 Discover
Credit Card Number
Exp Date:
Name as it appears on 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* Sorry we no longer accept American Express. MEDICAL HISTORY: If you are a returning camper and have no medical changes, the section below does not need to be completed. ALL Campers, Please check the Terms and Conditions Box before you Submit - Thank You, I look forward to seeing you in camp!
1. Are you allergic to any medication, food or bug 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
If yes to above, please list medications:
7. Do you have or have you ever had 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 sever neck injury? If Yes, please describe:
10. Have you ever been knocked out? 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? Please describe:
13. Have you ever injured your back?
14. Do you have back pain?	Never Seldom Occasionally Frequently Only with vigorous 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 other physical conditions which 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 registering party and Mile High Boot Camp, L.L.C., its officers, subsidiaries, affiliates, and executors in addition to the City of Aurora and Centennial, Colorado, Cherry Creek School District, Cherry Creek State Park, Stockmann Properties L.L.C. and the County of Arapahoe. The purpose of Mile High Boot Camp is to provide fitness instruction and coaching for various levels of athletes & individuals. The registering party hereby acknowledges that the following was explained to me and/or I agree to the following: 1. Acknowledges that Kelli 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 Mile High Boot Camp, L.L.C. does not guarantee neither good nor bad will occur nor guarantees the training advice given by Mile High Boot Camp, L.L.C. will produce good nor bad results. 3. Acknowledges that the registering party 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 registering party 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 registering party expressly waives, releases, discharges and agrees not to sue from any liability of death, disability, personal injury, or action of any kind Mile High Boot Camp, L.L.C. for the undersigned participating in said sporting events and/or training for said sporting events. 5. Acknowledges that the registering party is in good health and is able to participate in Adventure Boot Camp. (Please call if you have any questions before proceeding.) The registering party agrees that this is the full agreement between the parties, that Mile High Boot Camp, L.L.C. 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 not to use foul language during Boot Camp. Any violation will result in twenty push-ups per occurrence. I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Boot Camp. Any violation will result in twenty push-ups per occurrence. I understand there is NO REFUND policy, and a NO CREDIT policy (unless a doctor's note is provided to the instructor, at which time the instructor will make the call as to grant a credit or not) towards a future camp if I’m not able to complete the one I originally joined. Mile High Adventure Boot Camp 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 Mile High Adventure Boot Camp, 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 set my alarm and be at camp on time! If I show up late I will do Burpees until I may join in class. By checking the box to agree to all terms and conditions, I expressly waive, release, discharge, and relinquish Mile High Boot Camp, 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 Mile High Boot Camp, 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.

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