*First & Last Name

*Today's Date:

*Address 1:

*City:

*State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tenessee Texas Utah Vermont Virgina Washington Wisconsin West Virginia Wyoming

*Zip:

*Home Phone:

*Cell Phone:

*Email:
 (VERY important!  You will receive Boot Camp information here.)

*Current running level (1-10), ten being high.
please select one 1 - Low 2 3 4 5 6 7 8 9 10 - High
*Is this your first class with us?  If not, when was the last running class you took with us?
yes   no    last class dates
*Date of Birth

*How did you hear about us, or who can we thank for referring you?


You may choose to sign up for one 5-week session, or two 5-week sessions (for better results and to save you time from signing up again next month!).
Which dates are you signing up for (hold down the Ctrl button to select more than one)?
  Select 1 or 2 sessions March 31 - May 1 May 12 - June 13 June 23 - July 25 August 4 - September 5 September 15 - October 17 October 27 - December 5

You may choose to either sign up for running classes only, or running classes and boot camp!
Please select days and price:
  PLEASE CHOOSE ONE Running Class Only-5 weeks-15 classes $180 Running Class 5 weeks-15 sessions PLUS 8 boot camp classes $299 Running Class Only-10 weeks-30 classes $360 Running Class 10 weeks-30 sessions PLUS 16 boot camp classes $598
*Form of Payment: Check Visa Mastercard American Express Discover Cash
If paying by check, please make check out to: Jaime Hoben
Mailing address: 
8482 E. Meadowridge St., Anaheim Hills, CA 92808
 

Credit Card Number:	no spaces	Exp. Date:	1 2 3 4 5 6 7 8 9 10 11 12  /   2008 2009 2010 2011 2012 2013 2014 2015
Name on Credit Card:		CVC Code*:	(security code)

*Visa and MasterCard
In the signature box on the back of your Visa you should see a 16-digit credit card number followed by a special 3 digit code. This 3 digit code is your CVC.

American Express
On the front of your card next to your main credit card number look for a 4 digit code. This 4 digit number is the Card Security Code.

*Do you have any pain, previous surgeries, medication, injuries, etc. that may affect your running or should concern us?  Please describe all of them below:

My main goal is:

Comments:


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

RELEASE
This release is entered into between the undersigned and Jaime Hoben and Speedy Jane Running Class, its officers, subsidiaries, affiliates, and executors in addition to the Orange County Township. The purpose of Speedy Jane Running Class is to provide running 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. Acknowledges that Jaime Hoben is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.

2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but that Speedy Jane Running Class does not guarantee neither good nor bad will occur nor guarantees the training advice given by Speedy Jane Running Class will produce good nor bad results.

3. 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 contact a physician at once.

4. Acknowledges that running classes, 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 Speedy Jane Running Class or Jaime Hoben for the undersigned participating in said sporting events and/or training for said sporting events.

The Undersigned agrees that this is the full agreement between the parties, that Speedy Jane Running Class and Jaime Hoben 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.

PLEASE TYPE FULL NAME BELOW - By typing your name below, you agree that this is your electronic signature agreeing to ALL of stated above.