Group Training Intake Form

Group Training Intake Form

1 FREE Group Training Class with completion of this form!
Client Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*

MaleFemale
Email*
example@example.com
Phone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Health & Lifestyle*

	Yes	No
Do you smoke?
Have you had any surgery in the past?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you dealing with any injuries?
Do you play sports or other activities?
Do you feel pain while doing sports/exercise?

Are you experiencing any joint pain/discomfort? If so, please select all that apply*

NeckLeft ShoulderRight ShoulderThoracic Spine/Upper BackRight ElbowLeft ElbowLumbar Spine/Lower BackRight FootLeft AnkleLeft Wrist/HandRight Wrist/HandHips/PelvisLeft KneeRight KneeNo Pain or DiscomfortRight AnkleOtherNone of the Above
Are there any specific movement patterns that cause any pain/discomfort? Please explain
(example: pressing, pulling, walking, squatting/sitting)
Are you experiencing any of these symptoms? If so, please select all that apply*

NumbnessPain with coughing/sneezingNauseaVomitingFeverChanges in bowel or bladderTinglingNight SweatsExtreme FatigueNone of the Above
Please select current health conditions/diseases/illness you are suffering from. (select all that apply)

DiabetesHigh Blood PressureDepressionAnxietyArthritisChronic StressHeart DiseaseCancerStrokeKidney DiseaseAutoimmune DiseaseAddictionLunge DiseaseHigh CholesterolOtherNone of the Above
Please specify if you have current/previous health diseases/issues. (not listed)
Please state whether you take any medication.
How often can you exercise per week?*
Please select the best days you can exercise.*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Please select the class days and times you are interested in. (choose two class days/times)*

Tuesday (7am-8am)Tuesday (8:15am-9:15am)Tuesday (5pm-6pm)Tuesday (6:15pm-7:15pm)Thursday (7am-8am)Thursday (8:15am-9:15am)Thursday (5pm-6pm)Thursday (6:15pm-7:15pm)
What class are you interested in participating in?*

Beginners Strength FoundationsSpine and Core Reboot
What are your goals for training?*

Build strength and musclesReducing the stressLose weight/body fatIncrease motivationReduce joint painTraining for an event/specific sport
Release and Acknowledgement
I, {clientName}, hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all the responsibility for any undesired situations during training. I am informed that my information in this form will be kept confidential.

The fitness center has informed me that I am the only responsible party both for all the injuries during the fitness program and incorrect information. I release and discharge the fitness center trainers, administration and workers from any disclosure of my personal information in this Fitness Client Intake Form.

If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform the fitness trainers and authorities immediately.

Waiver of Liability

BY SIGNING and PARTICIPATING IN THE FREE CLASS, YOU ARE AGREEING TO ACKNOWLEDGEMENT OF ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF Elite Athletics Personal Training Program and/or its trainers and coaches. Signee acknowledges that Elite Athletics Personal Training Program hereunder includes participation in strenuous physical activities, including but not limited to, weight training and various aerobic/anaerobic exercises and mobility exercises, injury rehab, and soft tissue work. Signee acknowledges these Physical Activities involve inherent risk of physical injuries or other damages, including, but not limited to, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and other illness, soreness, or injury however caused, occurring during or after the Clients participation in the Physical Activities.
Date*

MonthDayYear
Date
Client Signature*

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Group Training Intake Form

Release and Acknowledgement