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St. Luke's Boot Camp Registration
October 6 - November 25 3 Days a Week for 8 Weeks 6-7 am, Tuesdays, Wednesdays, & Thursdays $260.00
 
1. Name *
 
2. Gender *
Female Male
 
3. Age *
 
4. Address *
 
5. City *
 
6. Zip *
 
7. Home Telephone *
 
8. Cell Phone
 
9. Email *
 
10. Emergency Contact *
 
11. Emergency Contact Telephone *
 
12. Allergies and physical concerns the staff should be aware of (if none, indicate "none") *
 
13. I recognize that there are inherent risks involved in this sport activity. In consideration of the services provided, I hereby release and hold harmless, St. Luke's Presbyterian Church and Scott Mandy, doing business as St. Luke's Boot Camp, and its directors, employees, and agents from any and all liability for injuries including those resulting in death, and illnesses incurred while attending Boot Camp or occurring as a result of having attended Boot Camp. I certify that I am in good health and am able to participate in all program activities. Furthermore, in the event of an emergency requiring medical attention, I shall pay for the services rendered. *
I agree I will not attend the Boot Camp


 
 
 

St. Luke's Presbyterian Church | 1978 Mt. Vernon Rd. Dunwoody, GA 30338 | (P) 770.393.1424 | (F)  770.393.3278

 

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