Benefits
  • Dramatic improvements in your physical well-being and your self-confidence
  • Increased strength and endurance
  • Free Pre- and post- evaluations to help you monitor your progress(BD100 value) +973 17100190
  • Loss of inches and a firmer body
  • Motivation and inspiration in a women's only or men's only team environment
  • Four weeks of fun and energizing activities designed to help you reach your goals
  • Nutritional education
Adventure Fitness Trainer
Call +973 17100190

Adventure Boot Camp,
created in Orange County, CA
is the hottest fitness trend
in the world!
Women's Fitness Camp in Montreal

Register for Boot Camp!

This is a Secure Registration Form
Secure Myrna's Boot Camp Registration Form
Use this online form if you are paying by credit card only.

All items are mandatory




First Name:
Last Name:
House#:
Road#:
Bloc#:
Area:
Profession:
Date of Birth:
Yes, you must include the year!		 Month   Day   Year  
I'm signing up for this camp:
I'm signing up for how many days/week:
This is my first camp: Yes No
If you answered "no", when was the last camp you attended:
Emergency Contact
& Phone:
Your Home Phone:
Work Phone:
E-mail Address:
I rate my current fitness level as a: (1-10), ten being high
I was referred by:
My main goal is to:
What was your search word, or how did you find us?
Set a password for logging in later
Notes:

Your credit card information is required at this time to process your registration.
Sorry, we can only accept Visa/Mastercard at this time.

Credit Card Number: Exp. Date: / 
Name on Credit Card: CVC Code*:   (security code)

* Visa and Mastercard
In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.

If paying by check, please make payable to "Ashe Wellness Consultancy W.L.L."
Confirmations and detailed instructions will be mailed prior to the start of Boot Camp.  Waiver must be signed prior to participation.

MEDICAL HISTORY
Please fill out the medical information below.
Even if you have before... sorry.

1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
    Please list 
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
    
3. Do you have a seizure disorder (epilepsy)? Yes No
4. Do you have diabetes Adult or Juvenile? Yes No
    List Medications:
5. Have you ever been found to be anemic (low blood count)? Yes No
6. Do you have High Blood Pressure (hypertension)? Yes No 
    List Medications:
7. Do you have or have you ever had the following diseases?

Heart Disease: Yes No

Lung Disease: Yes No

Kidney Disease: Yes No

Liver Disease: Yes No

8. Do you have asthma? Yes No. List Medications:
9. Have you ever had a severe neck injury? Describe:
10. Have you ever been knocked out? Describe:
11. Do you wear glasses or contact lenses? Yes No
12. Have you had a broken bone or fracture in the past 2 years?
     Describe:
13. Have you ever injured your back? Describe:
14. Do you have back pain? Never    Seldom    Occasionally    Frequently with vigorous exercise or heavy lifting
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
     Describe:
16. Do you have other physical conditions which cause pain? Describe:
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested? Yes No / If yes, what percent is it?
     
20. Are you training for a specific event?   
NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!

RELEASE

This release is entered into between the undersigned and Myrna Saliba and Myrna's Boot Camp, its officers, trainers, affiliates, executors. The purpose of Myrna's Boot Camp is to provide fitness instruction and coaching for various levels of athletes/individuals.

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

 1. Acknowledges that Myrna Saliba is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.

 2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Myrna Saliba and Myrna's Boot Camp does not guarantee neither good nor bad will occur nor guarantees the training advice given by Myrna Saliba and Myrna's Boot Camp will produce good nor bad results.

 3. 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.

 4. Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, weight training, obstacle courses, and any other related sports are an extreme test of one's mental and physical limits and carry 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 inherent dangers of the natural elements, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind Ashe Wellness W.L.L and Myrna Saliba and Myrna's Boot Camp for the undersigned participating in said sporting events and/or training for said sporting events.

 5. Acknowledges that the Adventure Boot Camp has NO cash refund. Participants are expected to be prepared, consult with their doctor, and take responsibility for being fit enough to attend boot camp, regardless of whatever advice Myrna Saliba or anyone at Myrna's Boot Camp may give. There are NO refunds, for any reason whatsoever after the camp has started. Only credit for a future camp will be considered. If cancellation is before camp starts, there will be a BD 40 administration fee that will not be refunded.

 6. Acknowledges and agrees to not start your own boot camp or similar program within 20 miles of Myrna's Boot Camp, and within two years of completing your last boot camp with Myrna's Boot Camp and Adventure Boot Camp.

 Please note above the number of days you have signed up for.

The Undersigned agrees that this is the full agreement between the parties, that Myrna Saliba, nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement freely and voluntarily without force or coercion.

Initial the following:

I will remember to set my alarm and be at camp on time.
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. Any violation will result in twenty push-ups per occurrence.
I agree that I will not consume alchohol during the month of Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree to follow a good nutritional, healthy diet and not eat junk food such as Hamburgers, Donuts, pizza and cakes during the course of Boot Camp.. Any violation will result in twenty push-ups per occurrence.
I understand that I could be asked to have my "before" & after" photos taken and I will have the right to accept or refuse. No photos will be taken of me without my prior consent for any promotional purposes.
I understand there is no refund policy, but I can receive a credit (for unused portion of camp) towards a future camp if I'm not able to complete the one I originally joined. Camp fees can not be used towards any other products or services provided by Myrna Saliba, UScanrun, Ashe Wellness W.L.L., Myrna Saliba Enterprises S.P.C. OR Myrna's Boot Camp.

Your signature will be required at the time of your evaluation and you agree to the terms now!

 ____________________
Signature
 ____________________
Printed Name
____________________
Date

(By submitting this form, you are agreeing to all of the above!)


 
 

Lose Weight, Feel Great!

Expected results when you complete camp are:
  • Substantial reduction in body fat
  • Greatly Improved Posture
  • Better Relaxation
  • Several pounds of weight loss
  • Measurable decrease in the midsection
  • Huge improvement in endurance
  • Enormous increase in strength
  • and 100% gain in self-confidence!