{"id":134,"date":"2014-02-15T18:48:50","date_gmt":"2014-02-16T02:48:50","guid":{"rendered":"http:\/\/progressiveelitetraining.com\/?page_id=134"},"modified":"2019-06-08T14:58:01","modified_gmt":"2019-06-08T21:58:01","slug":"progressive-elite-bootcamp-registration","status":"publish","type":"page","link":"https:\/\/progressiveelitetraining.com\/?page_id=134","title":{"rendered":"Progressive Elite Bootcamp Registration"},"content":{"rendered":"<style type=\"text\/css\">\n.fontStyle_header {\n\tfont-family: Arial, Helvetica, sans-serif;\n\tfont-size: 22px;\n\tline-height: 30px;\n\tfont-weight: bold;\n\tfont-style: italic;\n\tcolor:#4370b9;\n}\n.fontStyle_subheader {\n\tfont-family: Arial, Helvetica, sans-serif;\n\tfont-size:16px;\t\n}\n.fontStyle_standard {\n\tfont-family: Arial, Helvetica, sans-serif;\n\tfont-size: 15px;\n\ttext-align: left;\n}\n.fontLarger {\n\tfont-family: Arial, Helvetica, sans-serif;\n\tfont-size: larger;\n\tfont-weight: bold;\n}\n.nextButton {\n    background: url(.\/images\/next-button.png) no-repeat right top;\n\tmargin-top: -20px;\n    height:29px;\n    width:44px;\n    float:right;\n}\n.nextButton:hover {\n    background-position:right bottom;\n}\n.infoButton {\n    background: url(.\/images\/info-button.png) no-repeat right top;\n\tmargin-top: -20px;\n    height:30px;\n    width:31px;\n    float:right;\n}\n.infoButton:hover {\n    background-position:right bottom;\n}\n.registerButton {\n    background: url(.\/images\/register-button.png) no-repeat right top;\n    font-family:arial,helvetica,sans-serif; \n    font-size: 20px;\n    line-height: 60px;\n\tpadding-top: 0px;\n    height:70px;\n    width:560px;\n    float:right;\n}\n.registerButton:hover {\n    background-position:right bottom;\n}\n.tableWidthLimiter {\n\tmax-width:800px;\n} \n.mainTable {\n\tmargin-left: auto;\n    margin-right: auto;\t\n\tmax-width:800px;\n\tborder:none;\t\n}\ntd { \n    padding: 10px;\n}\nol { \n    padding-left: 30px;\n}\nul { \n    padding-left: 30px;\n}\n.image-left_text-middle > * {\n\tmargin: 0px 15px 0px 0px;\n  \tvertical-align: middle;\n\tfloat: left;<\/p>\n<p>}\n.clearfix_0 {\n    clear:both;\n    height:0px;\n    font-size:0px;\n    line-height:0px;\n}\n.clearfix_05 {\n    clear:both;\n    height:5px;\n    font-size:5px;\n    line-height:5px;\n}\n.clearfix_15 {\n    clear:both;\n    height:15px;\n    font-size:15px;\n    line-height:15px;\n}\n<\/style>\n<div style=\"position:relative; width:100%; max-width:800px; margin-left:auto; margin-right:auto\">\n<table class=\"mainTable\">\n<tr>\n<td align=\"left\" valign=\"middle\" bgcolor=\"#f2f2f2\"><span style=\"color: #000066;\"><b>Register online for a Fitness Bootcamp<br \/>\n<\/b><\/span><a href=\".\/?page_id=149\" class=\"infoButton\" title=\"more information about the training program\"><\/a><\/td>\n<\/tr>\n<tr>\n<td height=\"294\" align=\"left\" valign=\"top\" bgcolor=\"#f9f9f9\">\n<table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"10\">\n<tr>\n<td height=\"274\" align=\"left\" valign=\"top\">\n\n<!-- Fast Secure Contact Form plugin 4.0.53 - begin - FastSecureContactForm.com -->\r\n<div style=\"clear:both;\"><\/div>\n\r\n<div id=\"FSContact3\" style=\"width:99%; max-width:555px;\">\r\n<form action=\"https:\/\/progressiveelitetraining.com\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F134\" id=\"fscf_form3\" method=\"post\">\r\n\n<div id=\"fscf_div_clear3_0\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_0\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\r\n\t<div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_name3\">Name:<\/label>\n    <\/div>\r\n\t<div style=\"text-align:left;\">\r\n\t  <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_name3\" name=\"full_name\" value=\"\"  \/>\r\n\t<\/div>\r\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_1\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_1\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_email3\">Email:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_email3\" name=\"email\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_4\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_4\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_4\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_4\">Address<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_4\" name=\"address\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_5\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_5\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_5\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_5\">City<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_5\" name=\"city\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_6\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_6\" style=\"clear:left; float:left; width:99%; max-width:250px; margin-right:10px;\">\n    <div  id=\"fscf_label3_6\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_6\">Province\/State<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:300px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_6\" name=\"state\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n  <div id=\"fscf_div_follow3_7\" style=\"float:left; padding-left:10px; width:99%; max-width:250px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\" margin-left:40px;  margin-top:2px;\">ZIP&nbsp;<\/div>\n\n    <div  id=\"fscf_label3_7\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin-left:40px; width:80px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_7\" name=\"zip\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_9\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_9\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_9\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_9\">Country<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_9\" name=\"country\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_8\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_8\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_8\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_8\">Profession<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_8\" name=\"profession\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_10\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_10\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_10\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_10\">Date of Birth<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; width:100px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_10\" name=\"date-of-birth\" value=\"mm\/dd\/yyyy\"  size=\"15\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_11\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_11\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_11\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_11\">Home Phone<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; width:100px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_11\" name=\"phone-number\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_12\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_12\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_12\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_12\">Work Phone<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; width:100px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_12\" name=\"work-phone\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_13\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_13\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_13\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_13\">Cell Phone<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; width:100px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_13\" name=\"cell-phone\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_14\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_14\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_14\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_14\">I rate my current fitness level as a (1-10), ten being high<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;\" id=\"fscf_field3_14\" name=\"i-rate-my-current-fitness-level-as-a-1-1[]\">\n        <option value=\"\">Please select<\/option>\n        <option value=\"1\">1 low<\/option>\n        <option value=\"2\">2<\/option>\n        <option value=\"3\">3<\/option>\n        <option value=\"4\">4<\/option>\n        <option value=\"5\">5<\/option>\n        <option value=\"6\">6<\/option>\n        <option value=\"7\">7<\/option>\n        <option value=\"8\">8<\/option>\n        <option value=\"9\">9<\/option>\n        <option value=\"10\"> 10 high<\/option>\n      <\/select>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_15\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_15\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_15\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_15\">I was referred by<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_15\" name=\"i-was-referred-by\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_16\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_16\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_16\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_16\">How did you hear about us?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_16\" name=\"how-did-you-hear-about-us\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_17\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_17\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_17\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_17\">Please specify publication \/ website \/ friend or other referral<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_17\" name=\"please-specify-publication-website-frien\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_18\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_18\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_18\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_18\">This is my first camp<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_18_1\" name=\"this-is-my-first-camp\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_18_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_18_2\" name=\"this-is-my-first-camp\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_18_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_19\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_19\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_19\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_19\">My Main goal is<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_19\" name=\"my-main-goal-is\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_20\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_20\" style=\"clear:left; float:left; width:99%; max-width:250px; margin-right:10px;\">\n    <div  id=\"fscf_label3_20\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_20\">Name of Emergency Contact<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:300px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_20\" name=\"name-of-emergency-contact\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n  <div id=\"fscf_div_follow3_21\" style=\"float:left; padding-left:10px; width:99%; max-width:250px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\" margin-left:40px;  margin-top:2px;\">& Phone Number<\/div>\n\n    <div  id=\"fscf_label3_21\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin-left:40px; width:80px;FONT-FAMILY: Verdana,Helvetica; FONT-SIZE: 10px;\" type=\"text\" id=\"fscf_field3_21\" name=\"emergency-phone-number\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_23\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_23\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_23\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_23\">Choose your event Package\/Price<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"width:400px;\" id=\"fscf_field3_23\" name=\"choose-your-event-packageprice[]\">\n        <option value=\"\">Please select<\/option>\n        <option value=\"1\">3 days\/week Boot Camp = $169<\/option>\n        <option value=\"2\">3 days a week 1\/2 hour Power lunch slam = $129<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n(plus GST)<br>\r\n<!--<span style=\"font-size:smaller;\">prices include measurements and body fat % before and following your bootcamp.<br>Nutrition session included and nutrition guidance thru out your camp.<\/span>\r\n<hr>\r\n<span style=\"font-size:smaller;\"> $299 (5 days\/week) | *$249 (4days\/week) | *$199 (3days\/week)  + GST<br>*This option is for those who have other commitments in the early a.m.  Since it is only a 4-week class, we do prefer you to attend the full 5-day a week program for best results and overall work-out!   You can do it!! ) ! <\/span><hr>-->\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_71\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_71\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_71\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_71\">Time of day<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"width:400px;\" id=\"fscf_field3_71\" name=\"time-of-day[]\">\n        <option value=\"\">Please select<\/option>\n        <option value=\"1\">8:00am - 9:00 am women only (summer schedule)<\/option>\n        <option value=\"2\">9:00am - 10:00 am women only<\/option>\n        <option value=\"3\">5:30pm - 6:30 pm co-ed<\/option>\n        <option value=\"4\">8:30am - 9:30 am (Summer Camp only)<\/option>\n      <\/select>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_24\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_24\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_24\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_24\">Form of payment<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;\" id=\"fscf_field3_24\" name=\"form-of-payment[]\">\n        <option value=\"\">Please select<\/option>\n        <option value=\"1\">Cheque<\/option>\n        <option value=\"2\">Cash<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<span style=\"font-size:smaller;\">To be paid in person the week  before camp begins at a set date and time agreed upon<\/span><hr><!--<p style=\"font-weight:bold;\">MEDICAL HISTORY <br>(If you are a returning camper, only complete the sections that have changed.)<\/p>-->\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_25\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_25\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_25\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_25\">1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_25_1\" name=\"1-are-you-allergic-to-any-medication-asp\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_25_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_25_2\" name=\"1-are-you-allergic-to-any-medication-asp\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_25_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_26\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_26\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_26\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_26\">List medications you are allergic to:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_26\" name=\"list-medications-you-are-allergic-to\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<hr>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_27\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_27\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_27\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_27\">2. Do you take any prescribed medication on a permanent or semi-permanent basis?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_27_1\" name=\"2-do-you-take-any-prescribed-medication\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_27_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_27_2\" name=\"2-do-you-take-any-prescribed-medication\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_27_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_28\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_28\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_28\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_28\">List prescribed medications:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_28\" name=\"list-precribed-medications\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<hr>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_29\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_29\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_29\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_29\">3. Do you have a seizure disorder (epilepsy)?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_29_1\" name=\"3-do-you-have-a-seizure-disorder-epileps\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_29_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_29_2\" name=\"3-do-you-have-a-seizure-disorder-epileps\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_29_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_30\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_30\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_30\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_30\">List epilepsy medications:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_30\" name=\"list-epilepsy-medications\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_31\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_31\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_31\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_31\">4. Do you have diabetes Adult or Juvenile?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_31_1\" name=\"4-do-you-have-diabetes-adult-or-juvenile\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_31_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_31_2\" name=\"4-do-you-have-diabetes-adult-or-juvenile\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_31_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_32\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_32\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_32\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_32\">5. Have you ever been found to be anemic (low blood count)?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_32_1\" name=\"5-have-you-ever-been-found-to-be-anemic\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_32_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_32_2\" name=\"5-have-you-ever-been-found-to-be-anemic\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_32_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_33\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_33\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_33\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_33\">6. Do you have high blood pressure (hypertension)?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_33_1\" name=\"6-do-you-have-high-blood-pressure-hypert\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_33_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_33_2\" name=\"6-do-you-have-high-blood-pressure-hypert\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_33_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_34\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_34\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_34\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_34\">List high blood pressure medications:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_34\" name=\"list-high-blood-pressure-medications\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_35\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_35\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<p>7. Do you have or have you ever had the following diseases?\n\n    <div  id=\"fscf_label3_35\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_35\">Heart disease<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_35_1\" name=\"heart-disease\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_35_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_35_2\" name=\"heart-disease\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_35_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_36\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_36\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_36\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_36\">Lung disease<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_36_1\" name=\"lung-disease\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_36_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_36_2\" name=\"lung-disease\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_36_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_37\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_37\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_37\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_37\">Kidney disease<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_37_1\" name=\"kidney-disease\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_37_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_37_2\" name=\"kidney-disease\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_37_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_38\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_38\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_38\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_38\">Liver disease<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_38_1\" name=\"liver-disease\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_38_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_38_2\" name=\"liver-disease\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_38_2\">no<\/label><\/span>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/p>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_39\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_39\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_39\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_39\">8. Do you have asthma?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_39_1\" name=\"8-do-you-have-asthma\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_39_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_39_2\" name=\"8-do-you-have-asthma\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_39_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_40\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_40\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_40\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_40\">List asthma medications:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field3_40\" name=\"list-asthma-medications\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_41\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_41\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_41\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_41\">9. Have you ever had a neck injury? (if yes, describe)<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_41\" name=\"9-have-you-ever-had-a-neck-injury\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_42\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_42\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<strong>10. Have you ever had a shoulder injury?<\/strong> <br>If yes, is there any residual pain and are you receiving therapy?\n\n    <div  id=\"fscf_label3_42\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_42\" name=\"10-have-you-ever-had-a-shoulder-injury-i\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_43\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_43\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_43\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_43\">11. Have you ever been knocked out?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_43\" name=\"11-have-you-ever-been-knocked-out\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_44\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_44\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_44\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_44\">12. Do you wear glasses or contact lenses?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_44_1\" name=\"12-do-you-wear-glasses-or-contact-lenses\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_44_1\">yes<\/label><\/span>\n      <span><input type=\"radio\" style=\"width:22px; height:32px;\" id=\"fscf_field3_44_2\" name=\"12-do-you-wear-glasses-or-contact-lenses\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field3_44_2\">no<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_45\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_45\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_45\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_45\">13. Have you had a broken bone or fracture in the past 2 years?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_45\" name=\"13-have-you-had-a-broken-bone-or-fractur\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_46\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_46\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_46\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_46\">14. Have you ever injured your back?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_46\" name=\"14-have-you-ever-injured-your-back\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_47\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_47\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_47\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_47\">15. Do you have back pain?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;\" id=\"fscf_field3_47\" name=\"15-do-you-have-back-pain[]\">\n        <option value=\"\">Please select<\/option>\n        <option value=\"1\">never<\/option>\n        <option value=\"2\">seldom<\/option>\n        <option value=\"3\">occasionally<\/option>\n        <option value=\"4\">frequently<\/option>\n      <\/select>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_48\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_48\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_48\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_48\">16. Have you had knee pain in the past 6 months that has disabled you for longer than a week?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_48\" name=\"16-have-you-had-knee-pain-in-the-past-6\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_49\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_49\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_49\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_49\">17. Do you have other physical conditions which cause pain?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_49\" name=\"17-do-you-have-other-physical-conditions\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_50\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_50\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_50\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_50\">18. Detail any surgical procedures in the past 6 months:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_50\" name=\"18-detail-any-surgical-procedures-in-the\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_51\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_51\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_51\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_51\">19. What are your goals for your Progressive Elite Camp session?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_51\" name=\"19-what-are-your-goals-for-your-progress\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_52\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_52\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_52\" style=\"text-align:left; padding-top:5px;\">\r\n\t  <label style=\"text-align:left;\" for=\"fscf_field3_52\">20. Are you training for a specific event? If yes, explain:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field3_52\" name=\"20-are-you-training-for-a-specific-event\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<hr>\r\n<p>Before starting any fitness\/health\/nutrition program it is wise to seek your doctors advice. <\/p>\r\n<p>RELEASE FORM AND LIABILITY WAIVER. PLEASE READ, CHECK THE BOXES AND SIGN BELOW. <\/p>\r\n<p>This release is entered into between the undersigned and Progressive Elite Bootcamp, its officers, subsidiaries affiliates, and executors in addition to the city of Penticton. The purpose of Progressive Elite Bootcamp is to provide fitness instruction and coaching for various levels of athletes\/individuals <\/p><hr>\r\n<p><strong>The undersigned hereby acknowledges that the following was explained to me and or agree to the following:<\/strong><\/p>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_53\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_53\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_53\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_53\" name=\"acknowledges-that-sheila-kamaraus-is-not\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_53\">acknowledges that Sheila Kamaraus is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_54\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_54\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_54\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_54\" name=\"exerciser-hereby-stipulates-that-heshe-i\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_54\">exerciser hereby stipulates that he\/she is physically sound and that he\/she has approval to proceed with a routine of exercise.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_55\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_55\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_55\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_55\" name=\"limitations-of-exercise-if-any-it-is-fur\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_55\">LIMITATIONS OF EXERCISE IF ANY: it is further expressly agreed that all strength training, cardiovascular exercise, or any other exercise shall be undertaken by me at my sole risk and that Sheila Kamaraus her agents or employees shall not be liable to me for claims, demands, injuries, damages, actions or causes of action whatsoever, to my person or property arising out of or connected with the use by me of the services provided and of the premises where the same is located . I do hereby expressly forever release and discharge Sheila Kamaraus and her agents or employees from all such claims, demands, injuries, damages, actions or causes of action, from all acts of active or passive negligence on the part of Sheila Kamaraus and her agents or employees.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_56\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_56\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_56\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_56\" name=\"acknowledges-that-the-undersigned-has-be\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_56\">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 your training, or otherwise, that the undersigned should contact a physician at once.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_57\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_57\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_57\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_57\" name=\"acknowledges-that-bootcamps-running-hill\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_57\">acknowledges that bootcamps, running, hills, stairs, obstacle courses and any other related sports are an extreme test of one's mental and physical limits and carries with it potential for damage or loss of property, serious injury, and death. That the undersigned assumes the risks of participating in these types of events\/activities including the elements of a natural environment. That they are fit and they discharge and agree not to sue from any liability of death, disability, personal injury or action of any kind Progressive Elite Bootcamp for the undersigned participating in said sporting events and\/or training for said sporting events.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_58\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_58\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_58\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_58\" name=\"the-undersigned-has-entered-into-this-ag\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_58\">the undersigned has entered into this agreement free and voluntarily without force or coercion.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_59\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_59\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_59\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_59\" name=\"customer-client-agrees-to-confidentialit\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_59\">customer client agrees to confidentiality with respect to Progressive Elite Bootcamp and all services provided by the same. The undersigned agrees to refrain from disclosing directly or indirectly any and all aspects of Progressive Elite Bootcamp. The undersigned agrees to a non-compete within a 50 mile radius of Penticton for a period of 5 years from the date of participation.<\/label><\/span>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<br>\r\n<p>DO NOT SIGN THIS AGREEMENT UNLESS YOU UNDERSTAND THE TERMS COMPLETELY.  <br>\r\nIF YOU DO NOT UNDERSTAND YOU SHOULD SEEK LEGAL COUNSEL. <\/p>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear3_60\" style=\"clear:both;\">\n  <div id=\"fscf_div_field3_60\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label3_60\" style=\"text-align:left; padding-top:5px;\">\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:22px; height:32px;\" id=\"fscf_field3_60\" name=\"i-agree-not-to-use-foul-language-during\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field3_60\">I agree not to use foul language during my bootcamp ...if i do it will result in 25 push-ups of Sheila's choice.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\n\n<div id=\"fscf_submit_div3\" style=\"text-align:left; clear:both; padding-top:15px;\">\r\n\t\t<input type=\"submit\" id=\"fscf_submit3\" style=\"cursor:pointer; margin:0;\" value=\"Submit\" \/> \n<\/div>\n\n<input type=\"hidden\" name=\"fscf_submitted\" value=\"0\" \/>\n<input type=\"hidden\" name=\"fs_postonce_3\" value=\"6c95e5247f2bde64bff631fe3e1eba1b,1777506847\" \/>\n<input type=\"hidden\" name=\"si_contact_action\" value=\"send\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"mailto_id\" value=\"1\" \/>\n\n<\/form>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\n\n<!-- Fast Secure Contact Form plugin 4.0.53 - end - FastSecureContactForm.com -->\n<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<tr>\n<td height=\"80\" align=\"center\" valign=\"middle\" bgcolor=\"#f2f2f2\">\n<div style=\"max-width:520px; text-align:center; margin-left: auto; margin-right: auto; font-family:sans-serif; font-size:38px; color: #000066;\">\n<span style=\"float: left; margin: 0 30px 20px 0;\">Decide.<\/span><span style=\"float: left; margin: 0 30px 20px 0;\">Commit.<\/span><span style=\"float: left; margin: 0 30px 20px 0;\">Succeed.<\/span>\n<\/div>\n<\/td>\n<\/tr>\n<\/table>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Register online for a Fitness Bootcamp Decide.Commit.Succeed.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":9,"menu_order":32,"comment_status":"closed","ping_status":"closed","template":"page-fullwidth.php","meta":[],"_links":{"self":[{"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/pages\/134"}],"collection":[{"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=134"}],"version-history":[{"count":4,"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/pages\/134\/revisions"}],"predecessor-version":[{"id":587,"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/pages\/134\/revisions\/587"}],"up":[{"embeddable":true,"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=\/wp\/v2\/pages\/9"}],"wp:attachment":[{"href":"https:\/\/progressiveelitetraining.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}