Westchester Adventure Boot Camp Westchester Adventure Boot Camp

Your Complete Boot Camp Transformation

20 1-Hour Workouts
"Done-for-Your" Meal Plan
Before & After Assessment
Free T-Shirt


Somers Boot Camp Registration

Westchester Somers Boot Camp Class


Returning Campers - Click Here

You now have 2 options:
A. You can print this form and send it in with payment by mail
B. Register O
Fill out the online form below to register via internet. Click on Submit to go to the payment page.
Payment Page: Pay via Paypal. Choose your class and finish your online registration. A PayPal account is not required to pay via PayPal.

NOTE: Spaces fill quickly for this unique experience. We cannot guarantee your space until we have received payment.

If paying by check, please make check out to:
Westchester Somers Boot Camp
12 Hill Lane, Brewster, NY 10509
Phone: (914) 960-4494

If you choose option A, Print this page and mail it in with payment.
If you choose option B: Fill out the form below and Click on SUBMIT.

Registration Form

Personal Information

Personal Information

Current fitness level (10 is highest):
Is this your first camp:

Camp and Payment Information

What camp are you joining?
Camp Location & Time:

Choose your camp frequency and cost:
Form of payment:

Medical History

Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?

List Medications:
Do you take any prescribed medication on a permanent or semi-permanent basis?

List Medications:

Do you have a seizure disorder (epilepsy)?
Have you ever been found to be anemic (low blood count)?

Do you have diabetes Adult or Juvenile?

List Medications:
Do you have High Blood Pressure (hypertension)?

List Medications:

Do you wear glasses or contact lenses?
Do you have Heart Disease:

Do you have Lung Disease:
Do you have Kidney Disease:

Do you have Liver Disease:
Do you have Do you have Asthma?

List medications for Heart Disease, Lung Disease, Kidney Disease, Liver Disease, or Asthma:
Have you ever had a severe neck injury?

Have you ever been knocked out?
Have you had a broken bone or fracture in the past 2 years?

Have you had knee pain in the past 2 years that has disabled you for longer than a week?
Have you ever injured your back?

Describe any currect pain you may be experiencing:
Do you have other physical conditions which cause pain?

Have you had any surgical procedures:
What are your goals for the next three months?

Have you had your body fat tested?
Describe testing and results:
Are you training for a specific event?
If yes, explain:

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


In the spirit of harnessing your best effort and providing optimum results from your Boot Camp experience, we have established the following policies to which you will need to adhere. Please read and check each one.

I agree to all Terms and Conditions listed above.

Signature, Date and SPAM Verification

- Electronic Signature
- Date (MM/DD/YYYY)