PLEASE TAKE A FEW MOMENTS TO ANSWER THE FOLLOWING QUESTIONS.

PLEASE TAKE A FEW MOMENTS TO ANSWER THE FOLLOWING QUESTIONS.
Name

First NameLast Name
Phone

Area CodePhone Number
Sex (M/F)
Occupation
Email
example@example.com
IG Handle
It is our professional duty of care to ask all participants, no matter what age, to complete the following questions. Simply tick next to the relevant questions to indicate yes.
Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death?Are you on any prescribed medication?Have you been hospitalized recently?Are you pregnant?Have you given birth in the last 6 weeks?
Do you have, or have you had:

GoutStrokeDiabetesEpilepsyHerniaAsthmaGlandular FeverRheumatic FeverDizziness or FaintingStomach/Duodenal UlcerLiver or Kidney ConditionArthritisAny Heart ConditionHeart MurmurHigh Blood Pressure (Over 140/90)Palpitations or Pains in ChestRaised Cholesterol/TriglyceridesMascular Pain
Do you have any pain or major injuries in the following areas

NeckKneesBackAnklesOther
Please give us more information about your injuries/conditions
If you have ticked any of the above, please provide a signed medical clearance from your doctor before starting exercise or sign the self clearance section below.
Doctors clearance
Date

MonthDayYear
Date
I warrant that I am physically and mentally well enough to proceed with F45 TRAINING and any workshop/workouts offered at F45 Bala Cynwyd.

Clients self-clearance of the above conditions:
Signature
Date

MonthDayYear
Date
LIFESTYLE AND CURRENT EXERCISE HABITS
Are you currently exercising regularly?

YesNo
If yes, please give details
Type of exercise
Frequency (times per week)

123-45+
Do you smoke?

NoIf yes, how many per day?1-56-1010 +
Are you allergic to anything? Please list if so:
WHY ARE YOU PARTAKING IN THE F45 TRANSFORMATION CHALLENGE?
OVERALL GOALS

To reduce body fatTo improve aerobic capacity (heart/lung fitness)To gain muscleTo increase overall fitnessTo generally tone upTo gain strengthIncrease Energy
Please elaborate
GOALS FOR THIS CHALLENGE
Be as specific as possible. At least one must be something you can put a measurement on from your Fit3D scan. Break down your goals into smaller ones (maybe for each phase) so that you can celebrate your progress along the journey and keep motivated:
Goal 1.
Goal 2.
Goal 3.
During this Challenge is there a main Goal Category you would like to focus on? Example: 1 Fat Loss 2. Strength Gain. 3. Heathier Daily Habits
WHY are the above goals important to you? (Your why should be so compelling that writing it down will make you want to do something to achieve your goals NOW and be the reason that keeps you inspired and driven to complete the challenge!)
What has stopped or hindered you in the past in achieving your health and fitness goals?
Workout Schedule (preferred class time -morning, midday, evening & which days):
Dietary Plan (vegan, vegetarian, pescatarian, all/no restriction, Any allergies?)
Have you ever participated in a health challenge before, if so what did it entail and what were the results?
What are your main concerns in participating in the challenge (i.e dietary restrictions or about making enough workouts, etc.) Tell us so we can help best personally motivate you! Your goals are our goals!
What do you need from your coaches to best help you achieve your goals for this challenge?
Other information you would like to let us know
Emergency Contact
Phone Number

Area CodePhone Number
Release Form and Waiver
Name

I, NameLast Name
I, the participant named below, have agreed to participate in the F45 Challenge including Live and On Demand virtual workouts, exercise and training programs and any other services (fitness or otherwise) offered by F45 ("Workouts"

I acknowledge and agree that the Workouts:
- are a recreational sport activity; and
- may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities.
I hereby affirm, and I affirm each time I participate in a Workout, that:
- I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in the Workouts; and
- I am participating in the Workouts voluntarily and at my own risk.
I HEREBY RELEASE JMAC FITNESS LLC, F45 TRAINING PTY LTD, F45 TRAINING PTY LTD (ACN 162 731 900), F45 TRAINING INC, F45 TRAINING PRIVATE ASIA LTD, FUNCTIONAL 45 TRAINING LTD, F45 TRAINING CANADA LTD AND THEIR RELATED BODY CORPORATES, AFFILIATES, SUCCESSORs, ASSIGNEES,

FRANCHISEES, LICENSEES AND THEIR OFFICERS, AGENTS AND EMPLOYEES (THE "RELEASED PARTIES") FROM ANY CLAIMS, DEMANDS, AND CAUSES OF ACTION AS A RESULT OF MY VOLUNTARY PARTICIPATION IN THE WORKOUTS, TO THE MAXIMUM EXTENT PERMITTED BY LAW.

I FULLY UNDERSTAND THAT I MAY INJURE MYSELF AS A RESULT OF MY PARTICIPATION IN THE WORKOUTS AND I HEREBY RELEASE THE RELEASED PARTIES FROM ANY LIABILITY NOW OR IN THE FUTURE FOR CONDITIONS THAT I MAY OBTAIN DIRECTLY OR INDIRECTLY FROM PARTICIPATING IN THE

WORKOUTS, TO THE FULLEST EXTENT PERMITTED BY LAW. THESE CONDITIONS MAY INCLUDE, BUT ARE NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, MUSCLE PULLS, MUSCLE TEARS, BROKEN BONES, SHIN SPLINTS, HEAT PROSTRATION, INJURIES TO KNEES, INJURIES TO BACK, INJURIES TO FOOT, OR ANY OTHER ILLNESS OR SORENESS THAT I MAY INCUR, INCLUDING DEATH.

IHEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.
SIGNATURE
DATE

MonthDayYear
Date
MARKETING

I AGREE TO ALLOW F45 TRAINING BALA CYNWYD TO USE PICTURES, VIDEOS OR THE LIKE FOR POTENTIAL MARKETING MATERIAL AND ON SOCIAL MEDIA.
Signed
Date

MonthDayYear
Date
STATEMENT

I recognize that the Trainers of F45 Training Bala Cynwyd are not able to provide me with medical advice
and are NOT registered dietitians. The information provided by them is to be used as a guideline to the
limitations of my ability to exercise. I have answered questions to the best of my ability and understand
that I should consult my physician or relevant qualified professional on any matters regarding my health and diet.
Signed
Date

MonthDayYear
Date
Should be Empty:

Release Form and Waiver