Form has been printed
WAIVER - please print, fill out, and send with your child their first day.

For your child’s comfort and safety, please indicate any special conditions we may need to know about
(allergies, medical prescriptions, recent injuries or illnesses, etc.; use additional paper if necessary):
________________________________________________________________________________________________
_________________________________
Student: __________________________________________ Age: ______ Date of Birth: ______________
I hereby give consent for the above named child to participate in fitness activities provided by Boot Camp
Las Vegas for the 2009/2010 school year.  Parent/Guardian Name: ____________________________________
Day Phone:  ___________________
Parent/Guardian Name: ____________________________________ Day Phone:  ___________________
Address _______________________________________________________________________________
Alternate Phone Numbers (cell phone, work, etc.) ______________________________________________

ACKNOWLEDGMENT OF RISK AND CONSENT FOR TREATMENT: I understand that participating in fitness
activities can be an extremely valuable experience for young people.  Boot Camp Las Vegas makes every
attempt to employ the finest Youth Personal Trainers and supply children with the best equipment and
facilities.  I acknowledge that there are risks inherent in any children's program, including but not limited to
injury or death arising from: participation in sports and physical fitness; child’s failure to follow instructions
of supervisors; communicable illness; and independent acts of third parties not under the control of
supervisors. I acknowledge that all risks cannot be prevented, and assume those beyond the control of Boot
Camp Las Vegas.  I agree that the student is in good physical condition and has no disease or injury that
would keep him/her from taking part in these activities. I assume all risks and hazards incidental to such
participation.
In case of medical emergency, I understand that every reasonable attempt will be made to contact me, my
family physician, or the emergency contact named below.  However, in the event that I or my named contacts
cannot be reached, I give my permission to school personnel and/or Boot Camp Las Vegas representatives
in charge of the 2009/2010 Boot Camp Las Vegas fitness programs to secure emergency medical treatment
for my child.  I agree to pay for any charges for emergency medical treatment that are not covered by my
personal health insurance. This acknowledgment applies to the session indicated above and any additional
sessions of the 2009/2010 Boot Camp Las Vegas programs for which I may register my child.

Emergency Contact (other than parent/guardian):______________________ Phone: _________________
Health Insurance Co. & Policy No.: _________________________________ Phone: _________________
Family Physician: ______________________________________________   Phone: _________________
Media Release: I give permission for my child to be photographed, filmed, interviewed, and have work
samples published in print and/or on the Internet.
__ Yes __ No
I understand that the neither Clark County School District nor Boot Camp Las Vegas can accept responsibility
for personal items lost or stolen.

___________________________________                ___________________________________________
Parent/Guardian Name (Please Print)                 Parent/Guardian Signature (required)   Date

Student Pledge:  I agree to work enthusiastically to the full extent of my ability and to treat staff members and
other participants and guests with respect.  Any unsportsmanlike conduct will not be tolerated.  

Student Signature (required): ______________________________________________________________

Is the student allowed to walk home? (Y) (N) Will student go to safe key after boot camp? (Y) (N)

Parent Signature: ___________________  Date _________
After Printing (just highlight, right-click, and chose 'print') click below
Waiver
Print and fill out the waiver, sign, and send with your student
their first day. Your student will not be able to work out without
the waiver present.

After printing the waiver, go to the payment page to view your
payment options.
Just Need to Make Your Payment?
Receiving an Error Page?
Go to Step 3 (Payment Page)
(Registration form will go through even though
you receive the error page. Just click on the
above link.)
Payments and
registration will be
required two weeks
before the class
starts based on
availability.

The session will say
full if there are no
longer spots
available.
Boot Camp-style workouts for students
(702) 513-9422
Get fit for life