Instructors:

Casey Ericson
Caity Gildart

Locations:

Portland: Eastern Promenade (Meet at East End Beach Parking Lot)

Times:

Portland: 9:30 am - 10:30 am (Monday-Thursday)

Dates:

Ongoing (May - August)
All classes are held
on a drop-in basis

 

maine boot camp

Online Registration Form: Stroller Division

Class registration begins again in the Spring 2011. See you then!

Register Online in 2 Easy Steps!

To register for Maine Boot Camp,: Stroller Division please complete the following on-line registration form and then select your method of payment. (Please note a credit card transaction will be applied for all Paypal transactions.)

CAMP INFORMATION (*indicates required field)
Full Name*
Email Address*
Choose Your Primary Camp Location*
Please note class cards can be used at all locations
Choose Your Class Package*
Non-transferable and non-refundable.
All class cards issued expire 08/31/11.
Form of payment:*
Pay via Paypal. Choose your class and finish your online registration. (A PayPal account is not required to pay via PayPal.) Transaction fee applied when using a credit card.
I rate my current fitness level as a (1-10), 10 being high.*
Please list your goals for this camp session:
Are you training for a specific event? If yes, please list:
Are NEW to Stroller Boot Camp or RETURNING?* New (first class free)       Returning 
BABY/CHILD INFORMATION (*indicates required field)
First Child's Name* First Child's Age*
Second Child's Name Second Child's Age
PERSONAL INFORMATION & MEDICAL HISTORY UPDATES (*indicates required field)
Has there been any changes to your personal or medical information since the last camp you attended?* No       Yes 
Address* City*
State */ ZIP* / Profession*
Phone Number* Date of Birth* (mm/dd/yyyy)
Name of Emergency Contact & Phone Number*   
Name of Primary Care Physician & Phone Number*   
Insurance Company & Policy Number*   
Hospital Preference*
How did you hear about us?
Please specify (publication, search engine, friend, other referral)
Medical History (*indicates required field)
1. Has it been more than 6 weeks (8 weeks if you had a C-section delivery) since you have had your baby?* No       Yes 
2. Did you have any complications with your pregnancy?*. No       Yes 
Describe:
3. Did you have any complications with your labor and/or delivery?* No       Yes 
Describe:
4. Have you been diagnosed with having a rectus diastasis?* No       Yes 
5. Have you currently nursing?* No       Yes 
6. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?* No       Yes 
List Medications:
7. Do you take any prescribed medication on a permanent or
semi-permanent basis?*		 No       Yes 
List Medications:
8. Do you have or have you ever had the following conditions?  
*Heart Disease: No       Yes 
*Hypertension/High Blood Pressure: No       Yes 
*Lung Disease: No       Yes 
*Asthma: No       Yes 
*Kidney Disease: No       Yes 
*Seizure Disorder/Epilepsy: No       Yes 
*Diabetes: No       Yes 
*Liver Disease: No       Yes 
9. Have you ever had a serious neck injury? If yes, describe:
10. Have you had a broken bone or surgery in the past 2 years?
If yes describe:
11. Have you ever injured your back and/or had back pain that made it difficult to exercise? If yes, describe:
12. Have you ever had a knee injury and/or knee pain that made it difficult to exercise? If yes, describe:
13. Do you have any other conditions or ailments that may
limit your physical activity? If yes, describe:
14. Do you current participate in a regular exercise routine?
Describe frequency and type of activity.
Maine Boot Camp - Stroller Division Release

NOTICE: It is wise to seek your doctor's advice before beginning any health/fitness/nutrition program!

This release is entered into between the undersigned and Maine Boot Camp, its officers, subsidiaries, affiliates, and executors in addition to the Cape Elizabeth School Department and Cheverus High School. The purpose of Maine 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. I understand the risks associated with participation in the above listed activity. I hereby agree to release discharge, indemnify and hold Maine Boot Camp and their trainers, agents, and employees, Yarmouth Community Services and their agents and employees harmless from any liability claims, demand costs or damages arising out of said program activity which I might or my infant(s) or child sustain during participation. I have read this document carefully and sign it voluntarily with full knowledge of its significance.

2. Acknowledges that Maine Boot Camp trainers are not physicians and are not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice in relation to one’s participation in camp.

3. Acknowledges that all participants must be at least 6 weeks post partum (8 weeks for c-section deliveries) and must have the approval of their physician to participate in Maine Boot Camp – Stroller Division.

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

5. 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 notify his or her Maine Boot Camp trainer, cease participation in the program and contact a physician at once.

6. Acknowledges that It is Maine Boot Camp's recommendation for all participants to utilize a 3 wheel jogging stroller with 16” or 20” rear wheels for all classes, once your baby is old enough for this type of stroller (please consult your physician to determine the correct age for your baby). Maine Boot Camp also recommends using strollers with fixed front wheels opposed to joggers with a front swivel wheel for added safety.

7. Acknowledges that boot camps, aerobic classes, martial arts, kick boxing, running, kung-fu, 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 elements of a natural environment, 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 Maine Boot Camp and their trainers, agents, and employees, and Yarmouth Community Services and their agents and employees for the undersigned participating in said sporting events and/or training for said program and activities.

The Undersigned agrees that this is the full agreement between the parties, that Maine Boot Camp including its trainers 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.
Agreement and Signature (*indicates required field)
I agree to all Terms and Conditions listed above*
Electronic Signature*
Date (MM/DD/YYYY)*