Personal Trainer Client Intake and Liability Form

Full Name*

First NameLast Name

Date of Birth*

MonthDayYear

Height*

Feet

Inches

Weight*

lb

Phone Number*

Email*

example@example.com

What is the best way to contact you?*

Phone callEmailTextOther

What do you do for a living?*

What is the activity level at your job?*

None (seated only)Moderate (light activity such as walking)High (heavy labor, very active)

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

How would you rate the stress of your job?*

How would you rate the stress of your lifestyle?*

What are your hobbies, or what do you like to do in your spare time?*

Have you had any recent weight gain or loss?*

YesNo

If yes, please explain:

Is there any reason not mentioned why you should not follow a regular exercise program? (Please remember it is your responsibility to you to consult with a physician before starting an exercise routine)*

YesNo

If yes, please explain:

Which service(s) are you interested in? Check all that apply (we will chat about your selection in our initial chat, so you are not obligating yourself to anything currently)!*

Monthly online strength training and cardio coaching as well as vegan meal plans and macro coaching (US $250/month)Monthly online strength training and cardio coaching as well as macro coaching (US $200/month)Monthly online strength and cardio coaching (no nutrition coaching - US $100/month)Monthly online targeted flexibility or skill (handstands/backbends/arm balancing) coaching (US $75/month)One-time 90-minute consult (strength, flexibility, skills, or nutrition) (US $150)One-time 60-minute consult (strength, flexibility, skills, or nutrition) (US $100)

Which of the following goals best fit in with your goals for your training (select all that apply)?*

What are the top three goals you want to accomplish, in order of importance?*

Explain why these three goals are most important to you.*

What possible personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?*

How often are you willing to train per week to reach goals?*

Are you comfortable with meal prepping and cooking at home?

YesNo

Are you comfortable tracking your macros on an app like MyFitnessPal?

YesNo

Are you on any specific diet at this time?

YesNo

If yes to the prior question, please explain. If you are currently tracking your macros, please input those here as well.

Do you have a membership at a commercial gym?*

YesNo

If yes, what gym?

What equipment do you have access to at home?

Do you currently exercise on a regular basis?*

YesNo

If yes, how many days a week?

How long is each session in minutes?

Describe your exercise routine:

Do you currently participate in any competitive sports?*

YesNo

If yes, what sports and how often?

Have you trained with a personal trainer or online coach before?*

YesNo

If yes, was your previous experience negative or positive? Why?

Describe what you expect of me as your fitness coach.*

Please rate your mental readiness to make changes to reach your goal.*

Please rate your motivational level to do what it takes to reach your goal.*

What motivates you?

Need a strong motivator to push you to exerciseYou like to be informed about your program and how it is going to lead you to your goalsLike to try new things if they are effectiveWilling to push past your comfort level to reach your goalsIf I feel things are really hard I tend to back offNeed to be held accountable for what I am doingBeing sore the day after a workout tells me my workouts are workingOther

Uncommon Athlete LLC Online Training

Informed Consent Form

I give my consent to participate in the physical fitness program developed and conducted by Anjali Sareen (hereinafter "the Trainer").

Benefits

Participation in a regular program of physical activity has been shown to produce positive changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.

Risks

I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains, etc) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack, etc). I hereby certify I know of no medical problem that would increase my risk of illness and injury as a result of participation in a regular exercise program. I further certify that I am responsible to get a complete physical check by my primary care physician to ensure I am of good health and able to begin a new exercise program.

By signing this consent form, I understand I am personally responsible for my actions during my tenure with the Trainer and I waive the responsibility of the Trainer if I should incur any injury as a result of my participation in the fitness program.

I agree to the above terms and conditions:*

YesNo

Client Signature*

Today's Date*

Date

Uncommon Athlete LLC

Liability Waiver

I hereby agree that by signing this document, I consent to waive certain legal rights, including the right to sue the following party, and, if applicable, its owners, trainers, representatives, and facilities from any physical, material, tangible or intangible, loss or damages that may happen to me during my participation in any of the fitness services (hereinafter, "Fitness Services") undertaken while under their instruction or thereafter: Anjali Sareen (the "Fitness Provider").

I will be voluntarily participating in the Fitness Services that will be conducted by the Fitness Provider. These Fitness Services may include, but are not be limited to, the following:

Resistance Training
Aerobic Training
Interval/HIIT Training
Plyometrics
Sport Specific Training
Flexibility Training
Endurance Training

A check mark below indicate I have read, agree with and understand the following:*

It is my responsibility to consult a physician before participating in this or any fitness program and I affirm that I have no medical conditions that would restrict me from participating in any of the Fitness Services.I agree to hold the Fitness Provider, and if applicable, its owners, trainers, and representatives, harmless from any damage, whether tangible or intangible, that may happen to me while participating in the Fitness Services. Such injuries may include, but are not limited to, muscle strains, muscle sprains, muscle spasms, heart attacks, raised blood pressure, and broken, fractured, or dislocated bones.I agree that the Fitness Provider offers the Fitness Services with no guarantee of results. I agree that I am solely responsible to maintain the diet and fitness regime appropriate for my level of health and stamina, and I agree that any results that occur, whether positive or negative, are the effects of my own personal choices.I agree that participation in the Fitness Services is not a replacement for actual medical care, and that if I do experience medical issues, I will contact my doctor immediately.I agree and verify that all of the information that I have given the Fitness Provider and its representatives is accurate, up-to-date, and without the omission of any known medical issues.I agree and verify that If I have omitted any necessary personal information, whether knowingly or unknowingly, I will hold the Fitness Provider harmless against all liability for any damages that may occur to myself or to others because of my actions or inactions.I agree to keep the Fitness Provider apprised of any changes or upcoming changes concerning my physical health and personal information.I understand and agree that it is my responsibility to let the Fitness Provider know if I find myself in any pain or discomfort before, after, or during the Fitness Services.If I do require medical treatment or attention while or after participating in the Fitness Services, I agree that the medical costs are mine and mine alone and hold the Fitness Provider blameless from any charges, fees, or costs that my conditions may incur.

Client Signature*

Today's Date*

Date

Uncommon Athlete Coaching

Online Coaching Inquiry Form

Lifestyle Information

Goals

Diet History

Training and Exercise History

Mental Readiness/Personality