Nevada's First and Only Indoor Boot Camp Fitness Center!

All Ages - All Fitness Levels - On-Site Child Care - Morning and Evening Classes!

3476 Executive Pointe Way,  Carson City, NV 89706       

HOME
BOOT CAMPS/CLASSES
SCHEDULE
PRICING
THE INSTRUCTORS
6WW IN THE NEWS
FITNESS ARTICLES
TESTIMONIALS
FAQs- Your Questions Answered
CONTACT US

Corporate Accounts
CTRH
Costco
Marriott
Harley Davidson
Carson High School

Nationally Certified by

6weekworkout.com

6weekworkout.com

6weekworkout.com

6weekworkout.com

6weekworkout.com

 
*Returning members click HERE to skip this step

Basic Rate Sign up: Please fill out all required information and submit the form below once.

If you have already filled out the form and would like to make a payment, CLICK HERE

Email Address:*  
Name:*  
Gender:*  Male Female
Date of Birth- MM/DD/YYYY:*  
Height:*  
Weight:*  
Number of hours worked per week:*  Less than 20   21-40   41-60   Over 60
More thatn 25% of your daily time is spent:* Sitting   Lifting   Standing   Walking  Driving
Date of last medical physical exam:
CHECK MARK all prescribed medicines taken within the past 6 months: Blood thinner

Diabetic

Digitalis

Diuretic

Epilepsy Medication

 Heart rhythm Medication

High BP Medication

Insulin

Nitroglycerin

Other (specify below
Other (please specify):
Please list any orthopedic conditions, including any injuries, in the last 6 months:
CHECK MARK any symptoms that occur 2 or more times per month: Cough up blood

Abdominal pain

Low back pain

Leg pain

Arm/Shoulder pain

Chest pain

Swollen joints

 Feeling faint

Dizziness

Breathless from slight exertion

Palpation or fast heart beat

Unusual fatigue with normal activity

Other (specify below)
Other (please specify):
CHECK MARK any of the following for which you have been diagnosed or treated by a physician or health professional: Alcoholism

Anemia, Sickle cell

Anemia, other

Asthma

Back strain

Bleeding trait

Bronchitis, chronic

Stroke

Thyroid problem

Ulcer

Congenital defect

Diabetes

Emphysema

Epilepsy

Eye problems

Gout

Hearing loss

 Heart problems

Cancer

Cirrhosis

Concussion

Hyperlipidemia

Kidney problem

Mental illness

Neck strain

Obesity

Phlebitis

Rheumatoid arthritis

Stress

High blood pressure

HIV

Hypoglycemia

Other (specify below)

 
Other (please specify):  
CHECK MARK any surgeries you have had: Back (spine)

Neck (spine)

Heart

Kidney

Eyes

Joints

Ears

Hernia

Lung

Other (specify below)
Other (please specify):
Do you exercise regularly? (Check box for YES):  
How many days a week do you accumulate 30 minutes of MODERATE activity:*  
How many days per week do you normally spend at least 20 minutes in VIGOROUS exercise:*  
What activities do you engage in at least once a week:
Phone #:*  
Emergency Contact Name:  
Emergency Contact Phone #:  
What type of package are you choosing:*  
Length of membership:*  
How did you hear about us:  
I have read, and agree to the terms of the Informed Consent *  

*Required

 

HOME I BOOT CAMP I CLASSES I TRAINERS I ARTICLES I NEWS I TESTIMONIALS I CORPORATE PACKAGES I CONTACT

6 Week Workout, LLC 3691 S. Carson St., Carson City, NV 89701

♦SITE DESIGN BY COMMERCIALMAKER ♦