Step 1 of 8

Participant's information
Please review the following information carefully and make any
necessary corrections.
* Required field


Please note: at this time, the system only allows you to register one child at a time.

First name:	*
Last name:	*
Address:	*
Address:
City:	*
State:	Virginia Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware 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 Tennessee Texas Utah Vermont Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Virgin Islands Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Coahuila Colima Distrito Federal Durango Estado. de México Guanajuato Guerrero Hidalgo Jalisco Michoacán Morelos Nayarit Nuevo León Oaxaca Puebla Querétaro Quintana Roo San Luis Potosí Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatán Zacatecas *
Zip:	*
Phone:	Home Work Mobile Home Fax Work Fax Pager Main Other *
Phone:	Home Work Mobile Home Fax Work Fax Pager Main Other
Email:	*
Birthdate:	1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 *
Gender:	Male Female *
Fitness level:	Couch Dweller Fairly Active Serious Competitor Bring it on *
T-shirt size:	S M L XL 2XL 3XL 4XL *

Parent/Guardian Information

First name:
Last name:
Address:
Address:
City:
State:	Virginia Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware 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 Tennessee Texas Utah Vermont Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Virgin Islands Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Coahuila Colima Distrito Federal Durango Estado. de México Guanajuato Guerrero Hidalgo Jalisco Michoacán Morelos Nayarit Nuevo León Oaxaca Puebla Querétaro Quintana Roo San Luis Potosí Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatán Zacatecas
Zip:
Phone:
Phone:
Email:
Relationship:	Parent Child Sibling Spouse Guardian Grandchild Grandparent Cousin Other Family Other

Emergency Contact Information

Emergency contact:	*
Relationship:	Parent Child Sibling Spouse Guardian Grandchild Grandparent Cousin Other Family Other *
Phone:	*
Phone:

Program Code of Conduct

I understand that the X-TEAM FITNESS Program strives to provide a safe, friendly and non-threatening environment for all participants. I agree that as a condition to being allowed to participate in the X-TEAM FITNESS Program conducted by X-TEAM FITNESS, LLC., I will refrain from the use of profanity, inappropriate humor and conduct that may be considered offensive to other participants.

I also agree to comply with all rules, instructions, and orders given by staff members so as not to increase the risk of serious injury or death to myself and other participants.

I agree that if I fail to comply with these terms that I may not be allowed to continue participating in the Program. I also understand class fees including deposits are non-refundable.

I have read and accept this agreement

I do not accept this agreement

A copy of this agreement will be attached to your confirmation email for you to sign and fax

Membership Agreement and Waiver

I, , am interested in joining X-TEAM FITNESS, LLC. I, , understand that the Program is dangerous and poses a risk to life and limb, and I knowingly assume such risks. I recognize that exercise is not without varying degrees of risk to the musculosketal and/or cardiorespiratory system. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by X-TEAM FITNESS, LLC. 

I understand and have been informed that there exists the possibility of adverse changes during the exercise program. I have been informed that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and very rare instances of heart attack or even death. 

I, , HEREBY RELEASE AND HOLD HARMLESS FOR ALL TIME X-TEAM FITNESS, LLC., its affiliates, subsidiaries, agents, employees, instructors, officers, and directors, from all liability to me or my representatives for any injury, death, loss or damages, sustained by me as a result of participating in the Program, whether caused by the negligence of X-TEAM  FITNESS, LLC., and regardless of the location of the premises on which such injury, death, loss or damages occurs. I, , hereby release X-TEAM FITNESS, LLC as well as waive any and all claims and understand and assume any and all risk with participation in X-TEAM FITNESS.  

I understand that I must successfully complete this introductory course in order to qualify for membership. Upon successful completion I will be presented with all available membership options in the X-TEAM FITNESS program, which will require a separate monthly fee.  

I agree to pay X-TEAM FITNESS LLC, its successors or assigns (“X-TEAM”), the listed amount (“Service Fee”) in advance for participation in the selected X-Team Bootcamp program.  

Payment of the Service Fee shall be made in one installment, with full payment being due upon signing this agreement. I understand that full payment is required in advance of beginning the program. 

In the event that I cease, for any reason, to participate in the X-TEAM FITNESS program, I understand that I am still liable for the unpaid balance of the Service Fee, payment of which shall be due and payable as set forth above. I agree that I will be responsible for all reasonable legal fees and other costs incurred by X-TEAM FITNESS in collecting any amounts owing under this agreement, in addition to all other remedies available to X-TEAM FITNESS. 

X-TEAM FITNESS reserves the right from time to time to establish general policies that apply to all fitness program members regarding attendance, conduct, safety, contract cancellation and other relevant subjects, and to modify these policies. Any such policies will be posted on X-TEAM FITNESS’s website. I agree to abide by all such policies. 

This agreement shall remain in effect unless written notice to cancel is given by either X-TEAM FITNESS or me to the other party at least thirty (30) days prior to expiration of this agreement. This agreement may not be modified or amended, in whole or in part, without the written consent of both parties.  

In order to qualify for full refunds for Bootcamp registration fees, nutritional counseling and baseline testing, written notice of cancellation must be made at least ten (10) days prior to the first session. No refunds will be given for cancellations received nine (9) days or less prior to the start of any session. 

Cancellations must be written and submitted by postal mail to: X-Team Fitness, LLC, PO Box 4324, Midlothian VA 23112, or emailed to membership@xteamfitness.com . If emailed, please include “contract change request” in the subject line. 

REPRESENTS THAT SHE HAS READ, UNDERSTANDS, AND IS VOLUNTARILY SIGNING THIS RELEASE AND HOLD HARMLESS AGREEMENT, and further represents that no verbal statements have been made to the undersigned to induce Her to sign this agreement.

I have read and accept this agreement

I do not accept this agreement

A copy of this agreement will be attached to your confirmation email for you to sign and fax

How did you hear about X-Team Fitness?

Free Guest Pass Card Facebook Building Indeed Google Stonewall Sports Postcard Mania Trying to Adult Santer Gym Members Now PurePhit Next Level Fitness Brochure Groupon Living Social Attended Guest Day 10k Expo Booth Billboard Channel 6 Employer Flyer Friend Henrico Citizen Member Midlothian Exchange Richmond Experience CHAARG VCU Newspaper Article Other Race/Event Radio Burn and Brew Richmond Times Dispatch Showcase Richmond SEAL Team PT Unknown Instagram Website *

If referred by a member, please enter their name. If you have a Guest Pass with a special code, please enter it here.

Please list any family members currently participating in X-Team.

Please list any friends currently participating in X-Team.

Select membership plan

Which membership plan would you like to sign up for? *

Month-to-month membership -- $160 per month 6-month membership -- $140 per month 12-month membership -- $120 per month Student -- $90 per month 6-week session -- $295 per month Family Plan Offered periodically -- $0 per month

Preferred workout session

Please select the date you would like to attend:

Select... Wednesday, July 2, 2025Thursday, July 3, 2025Friday, July 4, 2025Saturday, July 5, 2025 *

Please select the time you would like to attend:

Select... 5:45 AM - 6:45 AM at U of R Jepson Alumni&&Wednesday, July 2, 20255:45 AM - 6:45 AM at X-Box&&Wednesday, July 2, 20257:15 AM - 8:15 AM at X-Box&&Wednesday, July 2, 20254:30 PM - 5:30 PM at X-Box&&Wednesday, July 2, 20256:00 PM - 7:00 PM at U of R Jepson Alumni&&Wednesday, July 2, 20257:30 PM - 8:30 PM at X-Box&&Wednesday, July 2, 20255:45 AM - 6:45 AM at Pony Pasture Rapids&&Thursday, July 3, 20255:45 AM - 6:45 AM at X-Box&&Thursday, July 3, 20257:15 AM - 8:15 AM at X-Box&&Thursday, July 3, 20254:30 PM - 5:30 PM at X-Box&&Thursday, July 3, 20256:00 PM - 7:00 PM at Pony Pasture Rapids&&Thursday, July 3, 20258:00 AM - 9:00 AM at Rockwood Park&&Friday, July 4, 20257:30 AM - 8:30 AM at Forest Hill Park&&Saturday, July 5, 20257:30 AM - 8:30 AM at X-Box&&Saturday, July 5, 20259:00 AM - 10:00 AM at X-Box&&Saturday, July 5, 2025 *

Payment Information

Do you have a Groupon or Living Social code?   Yes      No

Order Review

Please review the following for accuracy
Participant
Name:
Phone:	() -
Email:
Gender:	Female
Fitness level:
T-shirt size:
Age:	0
Emergency Contact
Emergency contact:
	() -
Program details
Program:	Adult 6-week Beginner Program
Date:	4/23/2017 6:00:00 AM
Payment information
Card type:
Card number:	xxxx-xxxx-xxxx-
Card security code:
Expires:	/
Amount to be charged:	$195.00
Billing Address:	Same as primary

Registration Confirmation

Thank you for signing up. Your registration has been processed. A copy of this receipt has been emailed to you. Also, a printable version of this page is available here.
Participant
Name:
Phone:	() -
Email:
Gender:	Female
Fitness level:
Age:	0
Emergency Contact
Emergency contact:
	() -
Program details
Program:	Adult 6-week Beginner Program
Date:	4/23/2017 6:00:00 AM
Payment information
Card type:
Card number:	xxxx-xxxx-xxxx-
Card security code:
Expires:	/
Amount charged:	$195.00
Billing Address:	Same as primary
Remember the following
	Wear good running shoes
	Wear comfortable clothing appropriate to the weather
	Come hydrated and bring water