Work with Coach JC

1

Full Name* This field is required.

First Name

Last Name

2

Email

example@example.com

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Phone Number

Area Code

Phone Number

4

Gender

Male

Female

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Date of Birth* This field is required.

6

Age

years

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Height

cm

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Weight

KG

9

What do you do for a living?

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Whats the activity level at your job?

none(seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

11

Do you follow a regular working schedule, do you work days, afternoon or nights?

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How often do you travel?

Rarely

A few times a year

A few times a month

Weekly

13

Please list the physical activities that you participate in outside of the gym and outside of work.:

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If you have any diagnosed health problems list the condition(s).

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If you are on any medications, please list them.

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What additional therapies are being undertaken for the given health problem(s)?

17

If you have any injuries, please list them.

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What additional therapies are being undertaken for the given injury?

19

Are you experiencing any stresses or motivational problems?

Yes

No

20

Has anyone of your immediate family developed heart disease before the age of 60?

Yes

No

21

Do any diseases run in your family?

Yes

No

22

Do you suffer from diabetes, asthma, high or low blood pressure?

Yes

No

23

if yes please list:

24

Are you a current cigarette smoker?

Yes

No

27

What following goals does best fit in with your wellness goals?

Improved health

Improved endurance

Increased strength

Increased muscle mass

Fat loss

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What is your current desired manifestation goal ?

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Why?

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How often are you willing to train to reach your wellness goals a weekl?* This field is required.

33

Are you currently excersising regulary (at least 3x per week)?

Yes

No

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Have you trained or worked with a personal trainer or coach before?

Yes

No

35

If yes what kind of coaching /training did you do:

37

The Financial Investment, what are you willing to invest financially?

$50.00 - $200.00

$300.00 - $700.00

$800.00 - $1600.00

$1700.00 - $2200.00

38

At what times during the day would you prefer to train or have your coaching sessions?

Morning

Mid-Day

Afternoon

Evening

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How often do you want to do workout a week?

Please Choose

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What are your expectations on me as your Personal Trainer/ Lifestyle / Manifestation Coach?

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1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 45 - 60 - 90 min in length depending on scheduled session. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

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Type a question

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I AGREE TO THE ABOVE TERMS & CONDITIONS!* This field is required.

Yes

No

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Group & Personal/ Coaching TERMS AND CONDITIONS 1. The parties agree to the following terms and conditions: a. Client is engaging Company for lifestyle fitness and/or nutrition coaching services to be provided by Jacqueline Lovett dba Jacqueline Chyi Co. Services include but not limited to : Coaching Sessions , Weekly Check in's , Meal Planning , Exercise Routine Planning , Goal Setting Work . c. Trainer/ Coach will create an exercise and/or nurtrition program geared to Client’s fitness level and experience in order to meet Client’s objectives. d. Client agrees to sign the Informed Consent and Assumption of Risk and Release of Liability. e. Client agrees to inform Jacqueliene Chyi Co. and Trainer of any and all conditions, medical or otherwise, that may affect his/her ability to participate in Training Sessions. 2. Training Sessions. Training Sessions may include, but are not limited to, the following activities: testing of physical fitness; exercise; aerobics and aerobic conditioning; cardiovascular training; weight lifting and training; and stretching. 3. Training Package and Payments Options Include Training Sessions + Nutrition Coaching 4. Monthly Sessions. All Coaching Sessions must be used within 30 days of billing cycle. 5. Cancellation of Coaching Session. Client shall provide twenty-four (24) hour notice of any necessary cancellation of a scheduled Training Session. Failure to provide twenty-four (24) hour notice shall result in Client being charged the full rate for the cancelled/missed Training Session. 6. Indemnity. Client agrees to indemnify and hold harmless Jacqueline Chyi Co. and its Trainer(s) for any injuries, illnesses, and the like experienced as the result of Client’s Training Sessions. 7. Termination. Jacqueline Chyi Co. requires a 30-90-Day committment for lifestyle /health/fitness/nutrition coaching. After the initial 30- 90-Day period expires, either Party may terminate this agreement with written notice to the other party 30-days prior to new billing cycle. 8. Warranties. While Jacqueline Chyi Co. and its Coache(s) fully believe exercise, specifically exercised personalized to Client, is beneficial to Client’s health and wellness, Company and its Coache(s) cannot guarantee the results of Training Sessions. Company and its Trainer’s make no representations and/or warranties that Client will lose weight, gain muscle mass, be able to engage in any specific physical and/or athletic activity, or will attain any other particular and/or specific results. Company and its Coache(s) strongly encourage Client to follow a healthy diet in conjunction with personal training and continued exercise. 8. Entire Agreement. This document reflects the entire agreement between the Parties and reflects a complete understanding of the Parties with respect to the subject matter. This Contract supersedes all prior written and oral representations. The Contract may not be amended, altered or supplemented except in writing signed by both Company and Client. 9. Dispute Resolution and Legal Fees. In the event of a dispute arising out of this Contract that cannot be resolved by mutual agreement, the Parties agree to engage in mediation. If the matter cannot be resolved through mediation, and legal action ensues, the successful party will be entitled to its legal fees, including, but not limited to its attorneys’ fees. 10. Legal and Binding Contract. This Contract is legal and binding between the Parties as stated above. This Contract may be entered into and is legal and binding both in the United States and throughout Europe. The Parties each represent that they have the authority to enter into this Contract. 11. Severability. If any provision of this Contract shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Contract is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited. 12. Waiver. The failure of either party to enforce any provision of this Contract shall not be construed as a waiver or limitation of that party’s right to subsequently enforce and compel strict compliance with every provision of this Contract. 13. Applicable Law. This Contract shall be governed and construed in accordance with the laws of the state where the Property is located, without giving effect to any conflicts of laws provisions. BY SIGNING BELOW, THE CLIENT ACKNOWLEDGES HAVING READ AND UNDERSTOOD THIS CONTRACT AND THAT THE CLIENT IS SATISFIED WITH THE TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT. THE CLIENT SHOULD NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN IT. INFORMED CONSENT AND ASSUMPTION OF RISK AND RELEASE OF LIABILITY This Informed Consent and Assumption of Risk and Release of Liability is material to the Personal Training Contract and is incorporated herein by reference. 1. Client certifies that he/she is of adequate physical condition to participate in physical exercise. 2. Client certifies that he/she assumes the risk of physical injury, whether minor, severe, or otherwise. 3. Client certifies that he/she will disclose to Trainer whenever suggested activities cause distress beyond Client’s threshold. 4. Client certifies that he/she will not hold JACQUELIENE CHYI CO. or its Trainer(s) liable for any physical injury, whether minor, severe, or otherwise that result from Training Sessions. 5. Client certifies that he/she assumes all responsibility for his/her participation in the Training Sessions. ACKNOWLEDGMENT I AM IN GOOD PHYSICAL AND MENTAL HEALTH AND DO NOT SUFFER FROM ANY HANDICAPS OR PHYSICAL CONDITIONS THAT COULD CONSTITUTE A DANGER TO MYSELF OR OTHERS AS A RESULT OF MY PARTICIPATION IN THE ACTIVITIES, AND I ACCEPT TO PARTICIPATE IN THE ACTIVITIES FREELY. PROMOTIONAL MATERIAL – I acknowledge that pictures and/or video may be taken of me by the Releasees while I participate in the Activities. I give my permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made by the Releasees. I agree that the Releasee has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation, etc for the use of such pictures, etc., and hereby release the Releasees and its agents and assigns from any and all claims which arise out of or are in any way connected with such use. By signing this waiver I agree to be added to the PlantBased Fitness mailing list of which I can opt-out at any time. JACQUELINE CHYI CO . CULTURE POLICY Creating a culture, atmosphere, and experience that produces incredible change and inspiration for Jacqueline Chyi Co. Clients will continue to be one of the highest priority at The JCC. 1. It is expected that all members are committed to and help develop this culture. 2. It is expected that you are positive on all fronts. 3. Negative talk about yourself or others will not be tolerated.We change lives with positive, motivating and encouraging words and actions. Negativity is entirely banned from our facility. 4. If at any point you have concerns regarding your Jacqueline Chyi Co. experience please let us know. We will handle the situation as quickly as possible. We welcome and encourage your feedback. 5. We actually care about each of our clients, and we want to help you! 6. It is respectful for you to arrive on time for your training sessions, schedule within at least 24 hours and cancel sessions within at least 24 hours to determined start time. 7. We promise to be here on time and ready for your scheduled appointment, and we hope that you will do the same. 8. Understand that your Trainer/Coach has your best interest in mind. Listen to your coach, follow their recommendations and rely on their expertise to get you great results. 9. You must understand that it is entirely up to you to put in the work needed to get amazing results. We ask that you follow our fitness and nutrtion coaching plan, listen to your coaches, give 100% effort during your training sessions and get to at least 90% of your scheduled sessions for best results. 10. Our experience has shown that consistency, progression, and priority is the keys to your success. Be consistent with your training and nutrition, always try to get better and make it a priority to get results. If you do these three things, you will be well on your way to success. If this waiver is delivered by any electronic means whatsoever and said delivery shall be of the same force and effect as the delivery of an original signature.