ST Strength Personal Training Application Form

Full Name

First NameLast Name

Date of birth

Phone Number

Area CodePhone Number

Email address

Emergency contact name and phone number:

Select which goals apply to you:

Tell me more about your health and fitness goals:

What do you currently do for exercise? Or what type of exercise have you done in the past?

What would you say is your biggest barrier to achieving your goals?

How will you feel when you have achieved these goals?

What type of exercise do you enjoy?

Do you have any injuries or health conditions?

How many training sessions will you do per week?

12

Please select the duration of your training sessions:

1 hour - $6045 minutes - $5030 minutes - $40

When would you like to start?

How would you like to pay for your sessions?

Weekly automatic paymentFortnightly automatic payment

What day of the week will you make your payments?

Do you have any questions?

Where did you hear about Sam Rice Fitness?

I have disclosed any injuries or health conditions that may affect my physical activity. I certify that my answers are true and correct and in the event that I am injured while performing exercises contained in this program, I release Sam Rice Fitness from any and all liability and resulting expenses.

Payments are due in advance and must be for the week in full i.e. if you have two training sessions scheduled, please make one payment for both sessions before the first session commences. Cancellations must be made a minimum of 12 hours before your scheduled session, or can be rescheduled at a time suitable to both parties. Any missed sessions can be made up for the following week or you may adjust the following week's payment if agreed upon by both parties.

Sam Rice Fitness personal training programs are designed for a minimum of 12 weeks. By completing this application form you are committing to 12 weeks of payments and training.

All program design, exercise prescription and health and fitness advice is the intellectual property of Sam Rice Fitness and must not be shared with a third party.

I realise that my answers to the above questions will be considered by Sam Rice Fitness in designing a personalised fitness training program.

Please confirm:*

I have Read, Understand and Agree to the Sam Rice Fitness Personal Training Terms and Conditions.

Signature*

Sam Rice Fitness Personal Training Application