Register for Agoura, Oak Park, Westlake, Thousand Oaks Boot Camps

COMPLETE THE FOLLOWING REGISTRATION FORM TO
ENROLL IN MOTIVFIT CLASSES & START YOUR FREE TRIAL

Note: Your FREE TRIAL will give you the opportunity to come try a motivFIT Workout for FREE and see if our program is for you. Upon completing your FREE TRIAL and you decide to stay on board, we will email you a website link directed to motivFIT's secure server, so that you can complete the financial portion of your enrollment for the Body Blast Challenge. We do not accept checks or cash.

**GROUPON CUSTOMERS DO NOT RECEIVE A FREE TRIAL**

AGOURA HILLS

5:30 - 6:30 AM Agoura Hills ( Map )

8:00 - 9:00 AM Oak Park ( Map )

6:00 - 7:00 PM Thousand Oaks/ Westlake ( Map )

Date you would like to start:

I HAVE RECEIVED ONE OF THE FOLLOWING DISCOUNTS


Groupon	Enter coupon code: (8 Digit Bar Code)
Groupon Purchased:	One-month Silver membership for $69 * One-month Platinum membership for $99 * Deals Featured prior to 5/23/13 5 Workouts for $19* 10 Workouts for $39 Platinum Package for $69
motivFIT Gift Card Note: You must present your Gift Card to your Fitness Coach at your first workout. This card is redeemable for the Body Blast Challenge at all motivFIT Locations. Gift card may not be combined with other promotions. May be used by first-time clients only. Sorry, not exchangeable for cash.

Corporate Rate Please enter code:

Special introductory offer from Marketing Material Enter code: Enter source:

COMPLETE YOUR PERSONAL INFORMATION

First Name:

Last Name

Street Address:

City

Email Address:

State Zip

Home Phone:

Work Phone

Cell Phone:

Profession

Date of Birth:

My main goal is:

EMERGENCY CONTACT INFORMATION

*Name:

*Phone:

MEDICAL HISTORY

*1. Has your doctor ever said that you have a heart condition and that you should only perform
physical activity recommended by a doctor?
Yes No

*2. Do you feel pain in your chest when you perform physical activity?
Yes No

*3. In the past month, have you had chest pain when you are not performing any physical activity?
Yes No

*4. Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes No

*5. Do you have a bone or joint problem that could be made worse by
a change in your physical activity?
Yes No

*6. Is your doctor currently prescribing any medications for your blood pressure or for a heart
condition?
Yes No

*7. Do you know of any other reason why you should not engage in physical activity?
Yes No

If you have answered " Yes" to one or more of the above questions, consult your
physician before engaging in physical activity. Tell your physician which questions
you answered "Yes" to. After a medical evaluation, seek advice from your physician
on what type of activity is suitable for your current condition.

*8. Do you have asthma?

Yes No

*9. Do you have High Blood Pressure?

Yes No

*10. Have you ever been diagnosed with Diabetes?

Yes No

*11. Have you ever been diagnosed with epilepsy or have a seizure disorder?

Yes No

*12. Do you take any prescribed medications?

Yes No

If Yes, List Meds:

*13. Are you allergic to any medications?

Yes No
If Yes, List Meds:

*14. Have you ever had any major injuries?

Yes No
If Yes, Describe:

*15. Have you had a broken bones or fractures ? If so, how long ago?

Yes No
If Yes, Describe:

*16. Do you have any pains in your neck or back pain?

Yes No
If Yes, Describe:

*17. Have you had any knee pain or injuries in the last 5 years?

Yes No
If Yes, Describe:

*18. What are your goals for the next six months?

How did you find us?

Please specify publication / website / friend
or other referral:

PARTICIPATION AGREEMENT; INFORMED CONSENT WAIVER; LIABILITY RELEASE;
& NON COMPETE AGREEMENT

MOTIVFIT MEMBER / PARTICIPANT ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF MOTIVFIT WORKOUTS, JEFF MORGAN, CARRIE MORGAN, FITNESS TRAINING FOR LIFE, LLC, WHICH IS DOING BUSINESS AS MOTIVFIT, IT'S EMPLOYEES, CONTRACTORS, OFFICERS, OR OWNER/S, THE CITY OF AGOUR HILLS, DEPARTMENT OF COMMUNITY SERVICES, THE CITY OF OAK PARK, RANCHO SIMI RECREATION PARK DISTRICT,THE CITY OF WESTLAKE VILLAGE, THE CITY OF THOUSAND OAKS,CONEJO RECREATION AND PARK DISTRICT, THE CITY OF NEWBURY PARK, THE CITY OF VENTURA, THE CITY OF CAMARILLO, THE CITY OF OXNARD, VENTURA COUNTY PARKS AND RECREATION, THE CITY OF HENDERSON, THE CITY OF LAS VEGAS, THE CITY OF NORTH LAS VEGAS, HENDERSON PARKS AND RECREATION, CLARK COUNTY PARKS AND RECREATION, THE STATE OF CALIFORNIA PARKS DEPARTMENT,NATIONAL PARKS SERVICE,UNITED STATES DEPARTMENT OF INTERIOR. PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES. MOTIVFIT BODY BLAST MEMBER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A MOTIVFIT MEMBER, SLIP AND FALL BY MOTIVFIT MEMBER, OR AN UNKNOWN HEALTH PROBLEM OF MOTIVFIT MEMBER. MOTIVFIT MEMBER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, MOTIVFIT MEMBER AFFIRMS THAT MOTIVFIT MEMBER IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES. MOTIVFIT MEMBER ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND MOTIVFIT MEMBER AGREES THAT IT IS THE RESPONSIBILITY OF THE MOTIVFIT MEMBER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN THE MOTIVFIT ACTIVITIES. BY CLICKING THE SUBMIT BUTTON AT THE BOTTOM OF THIS PAGE, MOTIVFIT MEMBER / PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. MOTIVFIT MEMBER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS. PARTICIPANT UNDERSTANDS PHOTOS OR VIDEO MAY BE TAKEN DURING THE COURSE OF THEIR INVOLVEMENT WITH MOTIVFIT, WHICH MAY BE USED FOR PROMOTIONAL PURPOSES. MOTIVFIT MEMBER /PARTICIPANT ACKNOWLEDGES THAT THEY ARE ASKING TO PARTICIPATE IN THIS PROGREESIVE FITNESS PROGRAM STRICTLY FOR PERSONAL REASONS TO IMPROVE THEIR FITNESS CONDITIONING AND MOTIVFIT MEMBER /PARTICIPANT ACKNOWLEDGES THAT AS A RESULT THEY WILL BE EXPOSED TO PROPRIETARY TRAINING TECHNIQUES OF MOTIVFIT WHICH ARE INTENDED FOR SAME; CONSEQUENTLY, MOTIVFIT MEMBER /PARTICIPANT ACHKNOWLEDGES AND AGREES THAT THEY ARE NOT AUTHORIZED TO RECORD THE PROGRAMMING OR DAILY PLANS OF MOTIVFIT, AND MOTIVFIT MEMBER /PARTICIPANT WILLINGLY SURRENDERS AND PROMISES THAT FOR A PERIOD OF NO LESS THAN 18 MONTHS AFTERWARD. MOTIVFIT MEMBER /PARTICIPANT WILL NOT DIRECTLY OR INDIRECTLY PARTICIPATE IN A BUSINESS THAT IS SIMILAR IN NATURE IN THE SAME GEOGRAPHIC AREA (WITHIN 45 MILES) OF ANY MOTIVFIT LOCATION. THIS INCLUDES MOTIVFIT MEMBER PARTICIPATING IN THEIR OWN BUSINESS OR AS A CO-OWNER, DIRECTOR, OFFICER, CONSULTANT, INDEPENDENT CONTRACTOR, EMPLOYEE, OR AGENT OF ANOTHER BUSINESS.

I Accept The Above Terms and Conditions

** PLEASE BE SURE TO READ THE AUTORESPONDER EMAIL THAT YOU'LL RECIEVE ONCE YOU SUBMIT THIS REGISTRATION. IT HAS VERY IMPORTANT INFORMATION REGARDING YOUR WORKOUT LOCATIONS, HOW TO BOOK YOUR CLASSES,ETC...**

YOU MUST ALLOW 24-48 HOURS FOR YOUR REGISTRATION TO BE PROCESSED AND SCHEDULING OF YOUR START DATE BY YOUR DESIGNATED FITNESS COACH!

motivFIT provides outdoor fitness boot camps, at home fitness challenges, corporate health and wellness programs, and corporate fitness challenges to the communities of Westlake Village, Thousand Oaks, Agoura Hills, Newbury Park, Oak Park, Camarillo, Simi Valley, Moorpark, Malibu, Oxnard, Ventura , Calabasas , and surrounding areas of the Conejo Valley , Ventura County, and Los Angeles County.