Gym health questionnaire Form

Welcome sheet - Client information
Full name*

First NameLast Name
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*
Emergency contact*

First NameLast Name
Phone number*
Clients information - Health questionnaire (Par-Q)
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q*

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel fain in your chest when you do physical activity?
n the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction
Initials*

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Client information - Liability waiver
I am aware of the risks in observing or participating in the activities offered and sponsored by Sincerely Fitness Philly LLC. and I understand that all sports 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 Sincerely Fitness Philly LLC. is not responsible for any damage that would be resulting from a fault of Sincerely Fitness Philly LLC. and its representatives.
Initials*

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Client information - 24h 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. Sincerely Fitness Philly LLC.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 Sincerely Fitness Philly LLC., or your trainer is notice prior to the session start time. No show are not eligible for the free cancellation.
Initials*

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Client information - Billing policy
I authorize Sincerely Fitness Philly LLC. to bill my credit card every last day of the month for the services provided during that month.
Initials*

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Client information - Signature
Signature*

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Date

JourMoisAnnée
Date
AM/PM Option
Should be Empty:

Welcome sheet - Client information

Clients information - Health questionnaire (Par-Q)

Client information - Liability waiver

Client information - 24h cancellation policy

Client information - Billing policy

Client information - Signature