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Application for rehabilitation (function improvement) camp

About a rehabilitation (function improvement) camp

Request on having you plan a camp

■The camping system (the following, camp),
B. using "BeMoLo® shoes" It is the staying, stay type pack system that can practice M.L.T. cam ® machine training, movement improvement, function improvement and is carried out "Beginning Movement Load training ®" as consistency * of the "BeMoLo® shoes" spread.

Therefore the participation of the camp intends for the person who can prepare for BeMoLo® shoes. At the time of the application the visit of the understanding to these and BeMoLo® shoes that preparations are possible, please to become essential.

*In the limited time called four days, "ability and inability for the movement that I want to demand" come out by use or nonuse of the BeMoLo shoes, and it is difficult to have you enter the having you participate in the situation not to know the BeMoLo shoes at all and is happy when you can give that you take such a form to understanding.

■Request
The world wing enterprise is a facility practicing movement (form) improvement, function improvement, trouble improvement based on Beginning Movement Load Theory ®/ Beginning Movement Load torengu ®.
Each country professional baseball player including the Major League, approach of the Olympics player of various competitions are known widely.
Moreover, an example much as the training that is effective for the paralysis improvement of people having a diagnosis of an intractable disease is inspected and is "the research facility" where the study with domestic and foreign doctors is pushed forward. In addition, even the development such as "B.M.L.T. cam ® machine" based on Beginning Movement Load Theory ® "BeMoLo® shoes" is known widely, and the world pays attention.

On the other hand, an example much as the training that is effective for the function paralysis improvement of people having a diagnosis of an intractable disease is inspected and is known as positioning of "the research facility" where in late years the study with not only the country but also doctors of the world is pushed forward widely.
 
I often accept it as second opinion from a medical institution for a rehabilitation (function improvement) camp in the various places of the visit and have you visit it for function improvement, function paralysis improvement from the whole country.
 
About the request, please transmit the following form after input.
The name, please fill in the name of a camp participation desired person.
The payment method which had you choose "a card" or "cash" as for the choice, please pay the difference in our receptionists after a camp.
 The person who had you choose "bank transfer" ships a bill after a camp in the designated address.
 
By appropriate and legitimate means, we acquire the full name of the customer, an address, a phone number, an e-mail address, a cell-phone number, belonging group, past trouble, illness or the name of disease as far as it is necessary for the achievement of the use purpose announcing the personal information of the customer on our homepage, and we use it based on a law about the protection of the personal information.
Apply after the above, understanding
It is a guide about the acceptance of the camp.

I have you confirm the following, and please let me know the hope than the inquiry form of "the camping system".
(even if it is the same purpose, approve that the balance of application situation (age and the item may be not accepted from))

(on having you plan a camp)
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①I start check & training at thermometry from 10:00 on the first day. When you are not in time for a start at 10:00, please plan in "a pre-night"
②In the case of participation in the one, the hotel charges of the student cope at a single use rate (3,850 yen) to become the setting with "a sharing a room rate". Thank you for your understanding.
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After having had confirm the above, than the inquiry form of the homepage "camping system"
Please input a hope day.
(because it is professional private training month during ※ January, there is not the acceptance)

[the competition camp hope] Each competition, training, training camp application form

[person wanting a function improvement camp] Application for rehabilitation (function improvement) camp form
 ※As our facilities are not medical facilities, the exercise permission by the doctor is necessary

Rehabilitation (function improvement) camp application form

The name ※required
 ※An example: Taro Yamada
Furigana ※required
(Katakana)
 ※An example: Yamada Taro
Sex ※required
A school name (team name) or company name ※required
Age (or a school year) ※required
Experience of the Beginning Movement Load training ※required
The member of partner facilities, please fill in facilities name.
Address ※required
Address ※required
 
Apartment building name
Phone number ※required
 ※An example: 012-345-6789
FAX number
 ※An example: 012-345-6789
E-mail address ※required



Only as for note) half size alphanumeric character
Return address you like ※required
Diagnosis name (now or symptom you have) ※required
The introducer
Family medical institution name
Please let me know the state of the current body or other anamneses ※required
About having preparation or not of the diagnosis image ※required

※I ask for the preparations for diagnosis images to be able to borrow from a medical institution to give an appropriate response.
Having videos (walks) which photographed a recent physical state or not

[any item]
If there are the videos which photographed the physical state in these days to do a judgment of the right or wrong of the acceptance, appropriate correspondence, please send it from this item.
About BeMoLo shoes ※required
※BeMoLo shoes becomes indispensable to participation, and the outside wears a practical skill when you want, and the business (at the time of the baseball participation BeMoLo® spikes-containing) is necessary, too.
Arrival ※required
/ /   :  ※When you are not in time for training start time, come by all means on the day before (you are going to arrive, and please input time)
Presence staying the union plaza ※required
*In the case of the other hotel, it becomes out of a pack bill application
Meal after the arrival ※required
Remarks
Transportation of the outward trip ※required
The departure date due date ※required
/ /   :  
Meal of the departure date ※required
Transportation of the return journey ※required
※Besides, if there are hope schedules possible. Please fill it out
The name of the attendant that staying is hoped for
※When smooth walks in you are difficult, an attendant, please be accompanied by all means
Having meal or not of the attendant
Having training or not of the attendant
Request address (when different from the address mentioned above)
 
Apartment building name
The request name
An emergency phone number and relations ※required
Choice of the payment method ※required
Agreement about the payment ※required
About a person of camp mentioned above, I promise that I (or a protector) take responsibility without delay and pay expense all to depend on a camp.
Agreement on participating ※required

1.Observe the terms of the gym and an accomodation clause on using a world wing and the union plaza, and agree to providing equipment according to instructions of the staff, and using it; 2. In the use, always note health care, and deal in the self-responsibility about the accidents such as the injury in facilities and the acute disease; 3. When smooth walks in you are difficult, agree to having accompany toward the attendant.
4.When it is judged that use of facilities in single Germany is difficult due to need of nursing care, assistance and others required, there is no objection even if use of facilities is canceled.
5.You have a chronic disease, and a person visiting a hospital for treatment comes to need the permission of the doctor (as our facilities are not medical facilities, the exercise permission by the doctor is necessary).

About the above, I promise to participate all after approval.
Subscription of the e-mail magazine ※required
Company
 World wing enterprise

(the headquarters)
〒680-0843
 1-73-3, Minamiyoshikata, Tottori-shi, Tottori
 TEL.0857-27-4773
(call time)
 Weekdays 9:00-13:00/15:00-18:00
-- - - - - -
It is for exclusive use of member
TEL.0857-22-2200
(call time)
 Weekdays 10:00-13:00/15:00-21:00
 Holiday 10:00-13:00

(Tokyo office)
〒140-0001
3, Kitashinagawa, Shinagawa-ku, Tokyo
・ planning meeting
・ B. M.L.T. development Planning Office
 *It is not training facilities

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