Clone of New Member Registration Form

New Member Registration

Congratulations! You have taken the first step to achieve your wellness goals.
Name

First NameMiddle NameLast Name
E-mail
Sex
Date of Birth

MonthDayYear
Height (inches)
Weight (pounds)
Contact Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
In case of emergency...
Emergency Contact:

First NameLast Name
Relationship
Contact Number

Area CodePhone Number
Taking any medications, currently?

YesNo
If yes, please list it here
Client Questionnaire: Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

YESNO
Do you feel pain in your chest when you do physical activity?

YESNO
In the past month, have you had chest pain when you were not doing physicalactivity?

YESNO
Do you lose balance because of dizziness or do you ever lose consciousness?

YESNO
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsened by a change in your physical activity?

YESNO
Has your doctor currently prescribed drugs (for example water pills) for your blood pressure or heart condition?

YESNO
Do you know of any other reason why you should not do physical activity?

YESNO
If you answered "YES" to any of the above, please explain below.
Liability Waiver:

I am aware of the risks in observing or participating in the activities offered and sponsored by TaylorMade Fitness and I understand that in all sports and/or fitness that I will execute and participate in are entirely at my own risk and perils. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that TaylorMade Fitness is responsible for any damage that would be resulting from a fault of TaylorMade Fitness and its representatives.
Type Name to Acknowledge Liability Waiver
Cancellation Policy:

All cancellations must be received at least 24h before your training session in order to avoid being charged. Clients who do not cancel with 24h notice will be charged 50% of a regular price session for the cancellation.

TaylorMade Fitness understands that emergencies happen. We provide every client with one free short-notice cancellation. You will not be charged for your first cancellation with less than 24h notice. Subsequent short notice cancellations will be charged for the session. The free short-notice cancellation only applies if TaylorMade Fitness or your trainer is notified prior to the session start time. No shows are not eligible for the free cancellation.
Type Name to Acknowledge Cancellation Policy
Select the package that will best suit your fitness goals.
Pick Your Desired Training*

Fitness BootCampUnlimited Group Sessions $80.00Unlimited Group Sessions/ 5 Individual Sessions $100.00Unlimited Group Sessions/Unlimited Individual Sessions $200.00Individual Sessions $25.00Group Sessions $12.00Skill and Agility Training (Youth) $20.00Mobile Training Session- Single Session $45.00Mobile Training Session- Weekly Session $135.00Mobile Training Group- Single Session $135Mobile Training Group- Monthly $150Pre-Recorded Virtual Training- 3 x Per Week $85.00Unlimited Group Sessions + Meal Plan + Shopping List $1005 Individual Sessions + Unlimited Group Sessions + Meal Plan + Shopping List $200
Signature*

Clear
Should be Empty: