Lifestyle Application

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Occupation

Instagram Handle

How did you hear about us?*

Other

Emergency Contact

First NameLast Name

Relationship

Emergency Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?*

YesNo

Do you frequently have pains in your chest when you perform physical activity?*

YesNo

Have you had chest pain when you were not doing physical activity?*

YesNo

Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?*

YesNo

Do you lose your balance due to dizziness or do you ever lose consciousness?*

YesNo

Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)?*

YesNo

Are you pregnant now or have given birth within the last 6 months?*

YesNo

Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?*

YesNo

Have you had a recent surgery?*

YesNo

Do you take any medications, either prescription or non-prescription, on a regular basis?*

YesNo

If yes, please please list all medications and what they are being used to treat.

Do you smoke?*

YesNo

If yes, how many per day?

Do you drink alcohol?*

YesNo

If yes, how often and how many glasses?

Is anyone in your family overweight?*

YesNo

Were you overweight as a child?*

YesNo

If yes, at what age?

Describe your job*

On a scale from 1-10, how would you rate your stress level (1=very low 10=very high)?

How many hours do you regularly sleep at night?

Rate your quality of sleep

Height (feet ' inches)

Current Weight (lbs)

Goal Weight (lbs)

Are you currently exercising regularly?

YesNo

Are there any goals or events that you're specifically getting in shape for? (Ex. wedding, vacation, photoshoot.)

YesNo

If Yes, Please specify.

What is your blood type?

What body parts do you want to focus on?

What age were you when you were last at your ideal body goals?

How many times a day do you usually eat (including snacks)?

Do you tend to skip meals?

YesNoSometimes

How much water do you consume daily?

On a scale of 1-10, how would you rate your current nutrition (1=very poor 10=excellent)?

Do you know how many calories you eat per day?

YesNo

If yes, please specify.

Please specify macros if you know them as well.

Have you ever weighed your food with a scale?

YesNo

Please list any supplements – herbal products, vitamins, minerals, muscle building aids, fat loss/thermogenics you are currently using below.

Do you have any allergies or food intolerances?

YesNo

If yes, please specify.

Please specify macros if you know them as well.

List 5 of your favourite healthy foods:

List 5 of your least favourite foods:

Are there any types of diets that have worked really well for you in the past? (i.e. keto, high carb, paleo, gluten free)

**Please detail your most typical daily diet*

What time do you typically wake up?

What time of day would you work out?

What time do you go to bed?

Is there any type of weight training style that has worked really well for you in the past?

Are there any exercises you can’t perform?

YesNo

If yes, please specify.

Where do you currently train?

GymHomeOther

Please specify what type of equipment you have access to.

If you train from home, please email a photo of your workout space and equipment/accessories.

If none, are you willing to purchase a few accessories for your home gym?

YesNo

Are you currently doing any cardio?

YesNo

Do you own a smartwatch that tracks heart rate and calories burned?

YesNo

If yes, please describe the amount and type of cardio

Are you willing to split up your cardio and weight workouts into AM/PM if necessary?

YesNo

Are you familiar with High Intensity Interval Training? (H.I.I.T)

YesNo

Realistically, how many days a week can you commit to exercise?

How much time would you like to spend during each exercise session?

What is your current training schedule? (ie. What do you train on which day? ) - If applicable

Please list 3 FITNESS related goals you would like to achieve in the next 3-12 months?

Where do you rate health in your life?

Low PriorityMedium PriorityHigh Priority

How committed are you to achieving your fitness goals?

Not verySomewhatVery

Which of the following coaching styles do you feel would be best suited to help you reach your fitness goals?

Direct and Tough Love (tell me how it is, don’t sugar coat things. I can handle criticismAuthoritatiranSupportive and NurturingDemocratic (share ideas)

What do you feel are obstacles or potential actions / behaviours / activities that could impede your progress towards accomplishing your goals?

Outline 3 methods that you plan to use to overcome these obstacles:

PARTICIPANT RELEASE AND KNOWLEDGE OF AGREEMENT.*

Name of participant

1) I, signed above, wish to participate in the exercise and training program offered. I understand there are inherent risks in participating in a program of strenuous exercise. I agree that ______ shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge _______ and its owners, employees, agents and/or assigns, from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators and assigns.*

Intitials

2) I certify that the answers to the questions outlined on the PAR-Q form are true and complete to the best of my knowledge. I acknowledge that medical clearance is required if I have answered “Yes” to any of the questions on the PAR-Q form. I understand and agree that it is my responsibility to inform my Personal Trainer of any conditions or changes in my health, now and ongoing, which might affect my ability to exercise safely and with minimal risk of injury.*

Intitials

3) I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel light-headed, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Personal Trainer.*

Initials

4) I understand the results of any fitness program cannot be guaranteed and my progress depends on my own personal effort and compliance with the program.*

Initials

5) I understand the results of any fitness program cannot be guaranteed and my progress depends on my own personal effort and compliance with the program.*

Initials

6) I understand that ____operates on a scheduled appointment basis for all Private Training sessions and thus, requires that I provide 24 hours’ notice when cancelling an appointment. No charge will be levied should I cancel with MORE than 24 hours’ notice given. Should I cancel a session with 24 hours prior notice, I will be charged $30 for the session. I understand that Team T-Rex recommends that all cancelled sessions be rescheduled to ensure consistency and fitness progress.*

Initials

7) I understand that during a personal training session, my trainer may have to use Touch Training to correct alignment, aid in stretching and/or to focus my concentration on a particular muscle area to be targeted. If I feel uncomfortable or experience any type of discomfort with Touch Training, I will immediately request that my trainer discontinue using this technique.*

Initials

8) Any photos or videos collected with the consent of the client during the course of the coaching may be used on any of the team social media pages and/or website for promotional purposes.*

Initials

9) I understand that programs, advice and dietary plans provided to me are property of _____ and I understand that they cannot be shared, reproduced, emailed or used in any way, including social media, without the written consent of a representative of ____*

Initials

10) I will support and respect teammates, coaches and officials in person and on social media.*

Initials

11) If I fail to uphold the Code of Conduct, coaches may use their discretion to terminate me as a client at any time.*

Initials

Please read and accept the terms below:*

I certify that I am at least 18 years of age, or have parental consent to participate in a ___ Training program.I have read this Release and Terms of Agreement and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance.

Name*

First NameLast Name

Signature*

Please attach 3 before photos: Front, Side, Back. Please also attach a photo of your workout space and equipment/accessories (if training from home).

You may submit these photos separately via email to info@teamtrextraining.com if you wish.

Lifestyle Form

Medical History