Step One

You MUST REGISTER before the first day of camp! Please fill out the form below so we have your medical/fittness information prior to your assessment

Step Two

We will be scheduling assessments every 30 minutes. We will need to assess your fittness level, bodyfat, measurments and your weight. Please wear loose fitting/comfortable clothing. Please call at least 1 week before camp begins to schedule your appointment. YOU WILL NOT BE ABLE TO PARTICIPATE UNTIL YOU'VE BEEN ASSESSED.

Contact information: Jennifer 260-249-7550

Fitness & Health Information Required* First Name  *   Field not valid (required or bad value) Last Name  *   Field not valid (required or bad value) E-Mail  *   Please enter a valid e-mail address Birth Date  *   Date format 01/01/1963 Address  *   Field not valid (required or bad value) City  *   Field not valid (required or bad value) State  *   Field not valid (required or bad value) Zip  *   Field not valid (required or bad value) Home Phone  *   Field not valid (required or bad value) Cell Phone Job Title Work Phone Emergency Name Emergency Number Rate Your Fitness Level  *  1   2   3   4   5   6   7   8   9   10    Field not valid (required or bad value) Main Goal Camp Goal Heard About Camp Payment Options  Check or Money Order   Credit Card   Online Payment  Pick Your Camp Dates: VIBC  Session 1  Session 2  Session 3  Session 4  Session 5  MEDICAL HISTORY QUESTIONAIRE 1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?  Yes   No  2. I do you take any prescribed medication on a permanent or semi-permanent basis?  Yes   No  3. Do you have a seizure disorder (epilepsy)?  Yes   No  4. Do you have diabetes; Type I (IDDM) or Type II (NIDM)?  Yes   No  5. Have you ever been found to be anemic (low blood count)?  Yes   No  6. Do you have High Blood Pressure (hypertension)?  Yes   No  7. Do you have or have you ever had Heart Disease?  Yes   No  8. Do you have or have you ever had Lung Disease?  Yes   No  9. Do you have or have you ever had Kidney Disease?  Yes   No  10. Do you have or have you ever had Liver Disease?  Yes   No  11. Do you have or have you ever had asthma?  Yes   No  12. Do you have or have you ever had severe neck injury?  Yes   No  13. Have you ever had been knocked out?  Yes   No  14. Have you had a broken bone or fracture in the past 2 years?  Yes   No  15. Do you wear glasses or contact lenses?  Yes   No  16. Have you ever injured your back?  Yes   No  17. Do you have back pain? If YES, select the best answer below.  Almost Never   Seldom   Occasionally   Frequently with vigorous exercise or heavy lifting  18. Have you had knee pain in the past 2 years that has disabled you for longer than a week?  Yes   No  19. Do you have other physical conditions, which cause pain?  Yes   No  20. Have you had any surgical procedures?  Yes   No  21. Have ever had your body fat tested?  Yes   No  22. Are you training for a specific event? Please explain. 23. What are your goals for the next three months? PLEASE EXPLAIN ALL “YES” ANSWERS BELOW. PLEASE REFERENCE THE QUESTION NUMBER.     Please enter the letters and numbers you see.