Attendance Options and Pricing!

You have 2 great options to choose from!
Choose the option that fits you best and register below
  • 4 Week Fitness Jumpstart program (Monday through Friday)

  • 5-day/week Program = Only $299 per camp
  • 3-day/week Program - Only $229 per camp
We recommend you attend 5-days per week to experience the greatest results!
(Please note: The price above is for the ENTIRE 4 weeks of camp!)
(Don't forget to ask us about our Inner Circle membership program where you can save up to 33% off your boot camp membership!

Code Pink Boot Camp - Katy

Address: 21734 Provincial Blvd.
                Katy, TX 77450

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You will need to bring tennis shoes, 3-5 lb. weights, 12-15 lb dumbell as your challenge weight, a mat, towel and water bottle!

Personal Information
First Name Address
Last Name State / ZIP /
City Phone Number
Date of Birth Mobile Number
Email Address
Self Assessment & Additional Information
How did you hear about us?:
My Main goal is:
Name of Emergency Contact & Phone Number |
Camp Information

Choose your Boot Camp Location.
Please check camp calendar for availability.

Choose your Boot Camp Program.

Choose Boot Camp Date

Boot Camp Time:

Form of payment:

Medical History (If you are a returning camper, only complete the sections that have changed.)
1. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
List Medications:
2. Do you take any prescribed medication on a permanent or semi-permanent basis?
List Medications:
3. Do you have a seizure disorder (epilepsy)?
4. Do you have diabetes Adult or Juvenile?
List Medications:
5. Have you ever been found to be anemic (low blood count)?
6. Do you have High Blood Pressure (hypertension)?
List Medications:
7. Do you have or have you ever had the following diseases?  
Heart Disease:
Lung Disease:
Kidney Disease:
Liver Disease:
8. Do you have asthma?
List Medications:
9. Have you ever had a severe neck injury?
10. Have you ever been knocked out?
11. Do you wear glasses or contact lenses?
12. Have you had a broken bone or fracture in the past 2 years?
13. Have you ever injured your back?
14. Do you have back pain?
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week?
16. Do you have other physical conditions which cause pain?
17. Detail any surgical procedures:
18. What are your goals for the next three months?
19. Have you had your body fat tested?
If yes, what percent is it?
20. Are you training for a specific event?
If yes, explain:
Release NOTICE: It is wise to seek your doctors advice before beginning any health/fitness/nutrition program!

This waiver and release is entered into between the undersigned and Paul Moran dba Code Pink Boot Camp Houston its instructors, officers, affiliates, and executors.

The purpose of the Code Pink Boot Camp Houston program is to provide fitness instruction and coaching for various levels of athletes/individuals.

The undersigned hereby acknowledges that the following was explained to me and/or agree to the following:

1. Acknowledges that the instructor is not a physician and is not trained in any way to provide medical diagnosis or any other type of medical advice.
2. Acknowledges that coaching/training is another tool for teaching athletes/individuals about themselves, but Code Pink Boot Camp Houston does not guarantee neither good nor bad will occur, nor guarantees the training advice given by Code Pink Boot Camp Houston or its instructors 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 boot camps, aerobic classes, martial arts, kick boxing, running, 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 and activities, 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 Code Pink Boot Camp Houston, its instructors, officers, affiliates, and executors for the undersigned participating in said sporting events and/or training.

The Undersigned agrees that this is the full agreement between the parties, that no representatives of Paul Moran or Code Pink Boot Camp Houston nor anyone else has 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.

Checkmark the following:
I agree not to use foul language during Code Pink Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree not to eat or say the words Twinkie, Donuts, Ho-Ho's, Ding Dong, or Cup Cake during the course of Code Pink Boot Camp. Any violation will result in twenty push-ups per occurrence.
I agree to show up for Boot Camp every day unless it is an excused absence from my doctor or pre-approved with Code Pink Boot Camp directors. Any violation will result in twenty push-ups per occurrence.
I understand that photos or video may be taken during the course of my involvement in Code Pink Boot Camp, which may be used for promotional purposes and I give my permission for their use.

I understand the following free trial, refund and makeup policy:

4-Week Jumpstart Refund Policy: If you are unable to attend camp due to circumstances out of your control, we can offer you a refund if you notify us prior to your session start date however we will charge a $50.00 cancellation fee. If we are notified after your session begins, we can only give you a credit to be used towards another boot camp. This credit is nontransferable. There is no cash refund. This is not negotiable.

Makeup Policy: We do NOT offer make-up days. You must commit to the program for which you have signed up; and in order to get results, you need to be consistent in your workouts. We recommend you attend 5-days per week to experience the greatest results. A minimum of 3-days per week is recommended to maintain your current fitness level and weight.

I will remember to set my alarm and be at camp on time.
I understand that diet and nutrition will effect my fitness goals and performance during boot camp.
I will bring a positive attitude, and expect to have fun.
Agreement and Signature
I agree to all Terms and Conditions listed above
Electronic Signature

Paul Moran dba Code Pink Boot Camp Houston
Phone: (281)769-2252