Tammie Leady's Body Physiques

"Your health is your wealth"

Emerson

Contact Us
For more information on services please contact:

tammie@tleady.com
Business phone (770) 364-5547

To sponsor IFBB Pro Tammie Leady Fitness competitions:
sponsors.tl@tleady.com

For Bookings and appearances:
appearances.tl@tleady.com

All correspondence can be mailed to:
PO Box 421743
Atlanta, GA 30342

Boot Camp Registration Form & Release 

 

First Name:
Last Name:        
Date of Birth:
Male or Female:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Country:
Daytime Phone:
Evening Phone:
Emergency Contact:
Emergency Contact Phone:
Email:
Would you like to receive our FREE newsletter?  Yes
  No
Camp Time:
My current fitness level is (1-10) 10 highest:
My main goal is to..
How did you hear about Tammie Leady's Body Physiques Boot Camp?
Do you have or had any of the following?
 

HEALTH HISTORY PROFILE

  Heart problems
  Headaches, dizziness, fainting or convulsions
  Cancer
  High blood pressure
  High cholesterol
  Back pain
  Asthma or lung problems
  Diabetes
  Chronic illness or disease
  Kidney or Liver disease
  Severe neck injury
  Knee or joint pain
Do you smoke?
Date of your last physical exam:
Do you have trouble sleeping?
Are you under the care of a physician? Explain:
Has your doctor recommended that you lose weight?:
List all medications currently taking (vitamins & prescribed):
Comments:
Consent:  

Informed Consent and Liability Waiver

In consideration of my participation in Boot Camp, hosted by Tammie Leady and Body Physiques, I agree to assume the risks incidental to such participation (which risks include, among other things, bodily injury and death) and, on my own behalf, and on behalf of my heirs, executors and administrators, I release and forever discharge the released parties defined below, of and from all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with my participation in the fitness bootcamp. 
 I further agree to indemnify and hold each of the released parties harmless against any and all such liabilities, claims, actions, damages, costs, or expenses, including but not limited to all attorney’s fees and disbursements.  
 

The released parties are Body Physiques and Tammie Leady, related and affiliated companies, and the officers, directors, employees, agents, representatives, volunteers, successors and assigns of each of the foregoing entities.  I understand that this release and indemnity agreement includes any claims based on negligence, action, inaction or fault of any of the above released parties and covers bodily injury and including death, whether suffered by me before, during after such participation.  I declare that I am physically fit and have no known medical condition which would prevent my full participation in the fitness bootcamp.  I have been informed that it is my responsibility to consult with a physician prior to and regarding my participation in this bootcamp.  I further authorize medical treatment for myself, at my cost, if the need arise. 

I further grant Body Physiques and Tammie Leady their sponsors, marketing partners, photographers as well as the media, the consent to photograph and or videotape me and my likeness for the use of  promotional and other materials, including but not limited to exhibitions, publicity, advertising without reservation or limitation without payment or other consideration made to me.   

This agreement is required in order to complete the registration process and further indicates that all the information on this form is accurate.  Alteration of this form is not permitted. 

I hereby affirm that I am over the age of 18 and I voluntarily agree to the terms stated in the informed consent, liability waiver and photo release.  No refunds will be given. I have read and fully understand the above.

 

 By submitting this form I  agree to the terms and conditions.

I agree to the terms and conditions:

Payment
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