Registration: Bootcamp

For Women

Mon./Wed./Fri. begins Mon. April 25th and runs through Fri. May 27th . Meets promptly at 5:20 a.m. at Verona Park Tennis Courts.**. $195.00 Please make checks payable to Patricia Haefeli.

Name: __________________________________________________

Address:________________________________________________

           _________________________________________________

          __________________________________________________

Date of Birth:_________________________________

Phone Number (Day) ___________________________

                      (Eves)___________________________

Email address:_________________________________________

I rate my current fitness level as (1-10), ten being high. ____________________

Previous exercise experience (type/duration)___________________________________________________

How long ago? ___________________________

Name of emergency contact & phone#:_____________________________                                               

What are your exercise goal(s)?  Circle one or more of the following:

Weight management           Increased flexibility             Toning/sculpting                          Increased aerobic capacity

**To be fair to all involved, bootcamp will begin promptly at 5:20 with the cardio portion of the program.  If you arrive late, you will have to try to meet up with group in progress.

Mail form to :Tricia Haefeli                                         H-973 509-1516        

               129 Llewellyn Rd.                                         C-973 495-0087

                   Montclair, NJ 07042