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Personal Information

Self Assessment & Additional Information

I rate my current fitness level as: (1-10)1 - Low2345 - Medium678910 - High Is this your first adventure boot camp:YesNo

Medical History

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



Do you wear glasses or contact lenses?NoYes Do you have Asthma?NoYes

PART 5: PARTICIPATION AGREEMENT, INFORMED CONSENT WAIVER, and LIABILITY RELEASE & NONCOMPETE AGREEMENT

This agreement is entered into willingly by me, an individual, and the entities or persons listed below in section (A) on account of my desire to participate in a voluntary fitness program. I affirm my understanding that this fitness program is an extreme test of a person's physical and mental limits and carries with it the potential for serious injury, death, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, personal health condition, lack of hydration, inadequate nourishment, equipment, vehicular traffic, and actions of other people including, but not limited to, participants, spectators, or trainers. I hereby assume all risks of participating in this activity. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. In consideration of my application and permitting me to participate in the Divine Fitness, LLC and Tri Valley Adventure Boot Camp program, I hereby take action for myself, my executors, administrators, next of kin, successors, and assigns as follows:

Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from Boot Camp training, THE FOLLOWING ENTITIES OR PERSONS:
Divine Fitness, LLC, Tri Valley Adventure Boot Camp, the City of Dublin, the City of Pleasanton, the City of Livermore, the City of the County of Alameda, Dublin Parks Department, Pleasanton Parks Department, Livermore Parks Department, the State of California Parks Department, and their instructors, officers, affiliates, employees, agents, board members, and executors

Indemnify and Hold Harmless the entities or persons mentioned in the above paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise.

I understand the purpose of the Adventure Boot Camp Program offered by Divine Fitness, LLC and Tri Valley Boot Camp. is to provide fitness instruction and coaching for various levels of athletes/individuals.

The undersigned hereby acknowledges that the following was explained to me and/or agree to the following:

Acknowledges that the instructor and assistant coaches are not physicians and are not trained in any way to provide medical diagnosis or any other type of medical advice.

Acknowledges that coaching/training provided by Divine Fitness, LLC and Tri Valley Boot Camp is designed to help increase health and fitness and Divine Fitness, LLC and Tri Valley Adventure Boot Camp is another tool for teaching athletes/individuals about themselves, and Divine Fitness, LLC and Tri Valley Boot Camp does not guarantee any specific fitness or health results by my participation.

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 their training, or otherwise, that they should stop the training session and should contact a physician at once.

Acknowledges that they are fit, do not have a physical injury or condition that would preclude participation in regular vigorous exercise and have not been advised otherwise by a qualified medical person, and they have a regular medical physician they can contact regarding any medical problems that they might develop.

Acknowledges I am asking to participate in this progressive fitness program strictly for personal reasons to improve my fitness conditioning and acknowledge that as a result I will be exposed to the proprietary training techniques of Divine Fitness, LLC and Tri Valley Adventure Boot Camp which are intended for same; consequently, I acknowledge and agree that I am notauthorized to record the programming or daily plans of Divine Fitness, LLC and Tri Valley Adventure Boot Camp, and I willing surrender and promise that, for a period of no less than 24 months afterward, I will not directly or indirectly participate in a business that is similar in nature and in the same geographic area (within a radius of 50 miles) of Divine Fitness, LLC and Tri Valley Boot Camp. This includes participating in my own business or as a co-owner, director, officer, consultant, independent contractor, employee or agent of another business.

Acknowledges that this Accident Waiver and Release of Liability form will be used by Divine Fitness, LLC and Tri Valley Boot Camp, in which the undersigned chooses to participate, and that it will govern my actions and responsibilities at during my activities with the Boot Camp.

I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during my Boot Camp training.

By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive physical exercise. I also acknowledge that I have been informed of the need to obtain a physician's examination and approval prior to beginning this exercise program. In signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including but not limited to abnormal blood pressure, fainting, heart attack or even death. I also understand that I may stop any training session at anytime. By signing this document, I assume all risk for my health and well being and any resultant injury or mishap that may affect my well being or health in any way and hold harmless of any responsibility, the instructor, facility or persons involved with the program and testing procedures.

The Undersigned agrees that this is the full agreement between the parties, that no representatives of Tri Valley Adventure Boot Camp or Divine Fitness, LLC, 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.

By Clicking the ACCEPT tab you have agreed to all terms here prior to starting your boot camp program.

In the spirit of harnessing your best effort and optimizing your results from Divine Fitness, LLC and Tri Valley BootCamp (as stated in the "What you can Expect" statistics), we have established the following personal performance pledges. This agreement is by and between you and yourself. Your greatest results will be achieved by following these edicts. Your choice to break any performance promises is breaking a promise to yourself, moves you away from your stated goals, and WILL result in other than best results. In excessive cases, it will cause other than favorable results such as fat mass gain, body composition increase, or lean mass loss. If you have genuine concern about being able to follow any of these promises, please contact us so we can discuss your program and work together to optimize your efforts and move you toward your performance goals!!

You will need to check your understanding to each pledge promise and demonstrate your agreement by signing at the bottom in order to join us in Boot Camp.

Click each of the following:
I agree that I will abstain from [not consume] alcohol during my Boot Camp period.

I agree to abstain from the use of foul language during Boot Camp training sessions.

I agree to abstain from eating or speaking the words Twinkie, Donuts, Cookies, potato chips, Brownie, Ho-Ho's, Ding Dong, or Cake during the course of Boot Camp.

I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Boot Camp directors.

I will arrive at camp ON TIME. [I will set 4 or more alarms as necessary to ensure.(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 Boot Camp, which may be used for promotional purposes and I provide my release for same. 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 my unused portion of camp that I purchase towards a future camp time if, for reasons beyond my control, I am not able to complete the one I originally joined. I understand that I have 3 months from the date of purchase to receive my credit for unused portions of any camp. After the 3 months it becomes null and voided. I understand that absences cannot be recouped or made up. Camp credits may not be used towards any other products or services provided by Divine Fitness, LLC or Tri Valley Boot Camp.

I understand that I may attend any boot camp sessioin time that is taught per the boot camp schedule found on the website of Tri Valley Boot Camp. Daily session time not to exceed 60 minutes per day.

I will follow proper dietary practices as explained by Coach Deborah Sandoval, fitness nutrition coach at Divine Fitness, LLC and Tri Valley Boot Camp head coach so that I can get maximum results from my 4 week boot camp challenge.

I have read and fully accept the Divine Fitness, LLC and Tri Valley Adventure Boot Camp Program Policies and Guidelines.

Your One on One Nutrition and Goal Setting Consult:

Once your registration is completed and your payment is received to reserve your spot in boot camp we will be contacting you to schedule your nutrition consult with Deborah Sandoval directly.

If you are not contacted within 24 hours of registration please contact us right away at 925-526-0157 or email to info@trivalleybootcamp.com

Click Here to agree to all Terms and Conditions Select YesYesNo