Personal Trainer Client Intake Form

Client Waitlist

Fill out the form below to be added to the waitlist for summer training between May-July. Final applications are to be sent by April 30th, 2024.
Name

First NameLast Name
Birth Date

MonthDayYear
Gender

Other
Pronouns?
Why do you want to train martial arts?
What is your daily fitness routine?
Have you ever trained martial arts before?
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
Do you smoke?
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

1

2

3

4

5

1 is Low, 5 is High
What do you hope to gain out of martial arts training?
Have you obtained your recent vaccinations as of today?
I ask that you wear a KN95 mask when training to avoid getting teammates and community members sick in response to recent surges in COVID, flu, and RSV. Would this require accommodations?
How often do you want to train in a week? This will help determine what program to get you on.
Preferred training times? All sessions run about 60 minutes.
Please rate your readiness at the moment.

1

2

3

4

5

1 is Worst, 5 is Best
To make this affordable as a way to assess community interest, I ask for a $20 drop-in fee per session. Would this be affordable? As a disclaimer: All sales are final.
There are no contracts for your training packages but missed sessions are non-refundable. Is this okay with you? You also always have the option renew your package if you would like to continue.
Do you live in Richmond, VA?
Type in anything that can or will potentially put barriers to your training progress. My preferred training method requires more individual input and autonomy on the part of the client so it’s important than even when we check-in, I’m providing information that’s relevant to your current life conditions.
How were you referred to me?
We state: BLACK DIAMOND PERSONAL TRAINING, LLC is not a licensed dietitian or medical professional. It is of best interest for anyone looking to start a fitness program to consult a physician. Before submitting this application, please read and understand the following: You (customer)understand that you (customer) may injure yourself as a result of participation in an exercise program or martial arts training and hereby release Black Diamond Personal Training LLC from any liability now or in the future for any injury or illness however caused, occurring during or after my participation in the exercise programming offered. By submitting this application, you state that in consideration of your participation in an exercise program from Black Diamond Personal Training, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless, Black Diamond Personal Training from any claims arising from your participation in the exercise program. By submitting this application, you affirm that you have read, have been honest with Black Diamond Personal Training and also fully understand the above information. You have been given the opportunity to present questions in all related matters.
Should be Empty:

Client Waitlist