PERSONAL TRAINING CLIENT FORM

PERSONAL TRAINING CLIENT FORM
Full name

First NameLast Name
Birth Date

MonthDayYear
E-mail
Phone Number

Area CodePhone Number
Emergency contact

First NameLast Name
Which of these are you seeking? (Click all that are applicable)
What are your top fitness goals? Why are they so important to you? Please explain...
Exercise and Sport History
Do you have an Injury? How did it happen? How does it affect you? If so please explain...
What type of service are you seeking?
If seeking Personal Training, how many days a week would you like to train?
How can I as your Personal Trainer/Coach best help you in reaching your goals?
Clients informations - 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

Rows	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
Client informations - Liability waiver
I am aware of the risks in observing or participating in the activities offered by Colin Charlet 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. You acknowledge that all sessions have a 12 hour cancellation policy and that you may be charged should you fail to meet this requirement (if the Trainer cancels within this period the session will not be lost)
Initials
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