• Mutated Physiques LLC

    Fitness Client Intake Form
  • Birth Date
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Rows
  • Please select the best days you can exercise.
  • Please select the best times you can exercise.
  • What are your goals for training?
  • Release and Acknowledgment

  • Congratulations on your decision to participate in an exercise program! With the help of your personal trainer, you greatly improve your ability to accomplish your training goals faster, safer, and with maximum benefits. The knowledge shared in these training sessions can be used for a lifetime.

    In order to maximize progress, it will be necessary for you to follow program guidelines during supervised and (if applicable) unsupervised training days. Remember, exercise and healthy eating are EQUALLY important!

    During your exercise program, every effort will be made to assure your safety. However, as with any exercise program, there are risks, including increased heart stress and the chance of musculoskeletal injuries. In volunteering for this program, you agree to assume responsibility for these risks and waive any possibility for personal damage. You also agree that, to your knowledge, you have no limiting physical conditions or disability that would preclude an exercise program.

    By signing below, you accept full responsibility for your own health and well-being AND you acknowledge an understanding that no responsibility is assumed by the leaders of the program.

    It is recommended that all program participants work with their Trainer three (3) times per week.

    However, due to scheduling conflicts and financial considerations, a combination of supervised and unsupervised workouts is possible.

     


    Training Terms and Conditions

    1. Private and Semi-Private training sessions that are not rescheduled or canceled 24 hours in advance will result in forfeiture of the session and a loss of the financial investment at the rate of one session.

    2. Clients arriving late will receive the remaining scheduled session time, unless other arrangements have been previously made with the Owner.

    3. The expiration policy requires completion of all personal training sessions (private or semi-private) within 60 days from the date of the purchase. Personal training sessions are void after this time period.

    4. No personal training refunds will be issued for any reason, including but not limited to relocation, illness, and unused sessions.

     


    RULES AND REGULATIONS TO KEEP EVERYONE SAFE

    All Mutated Physiques LLC rules and regulations are made with the best interest of our members in mind.

     

    • Do not wear jewelry or jeans or belts with buckles during use of upholstered equipment.
    • Socks and clean closed toe shoes are required. Sandals may not be worn on the workout floor. All members must wear shirts.
    • Please wipe sweat off the equipment and clean the equipment with the provided disinfectant to help keep everyone healthy.
    • No food on the workout floor. Please use non-spill containers for fluid replacements.
    • No children under 13 allowed unless special consideration is granted by Owner.
    • PLEASE DO NOT SLAM OR DROP WEIGHTS, BARS, DUMBBELLS, WEIGHT STACKS, BENCHES OR ACCESSORIES.
    • PLEASE BREAK DOWN YOUR WEIGHTS AND RETURN ALL EQUIPMENT TO THE RACKS FOR EASE OF USE FOR THE NEXT CUSTOMER.
    • NO SMOKING, CHEWING OF TOBACCO OR DRINKING OF ALCOHOLIC BEVERAGES OR THE USE OF MARIJUANA OR ILLEGAL DRUGS WILL BE
      PERMITTED ON THE PREMISES.
    • ALL MEMBERS, GUESTS AND STAFF WILL BE TREATED WITH RESPECT AND DIGNITY. THIS INCLUDES ABSENCE OF PROFANITY.

     

    Cancellation/Pause Policy 

    We do not have a cancellation policy. Here at Mutated Physiques LLC we strive to have the best service to keep you coming back for as long as possible. We understand that things may come up or the facility may not be the right fit for everyone and clients may cancel their membership at any time. If a client wishes to pause their membership due to vacations; please just make Mutated Physiques LLC aware and we may pause the membership for up to 30 days to be sure you do not lose any previously purchased sessions.

     

    Client Acknowledgment and Exculpatory Agreement

     

    I acknowledge that I have received the Mutated Physiques LLC Rules and Regulations above and I hereby agree to abide by and observe all the rules, regulations, policies and customs that are or may be in effect during the term of said membership. In the event that the Member fails to conduct him or herself in the manner prescribed and agreed upon herein, Mutated Physiques LLC shall not be liable for any resulting injury, loss or damage occasioned by such failure. Mutated Physiques LLC reserves the right to terminate any membership, for cause, without refund. “For cause” includes violation of Mutated Physiques LLC rules and regulations.

    Facilities, equipment, hours, services, regulations and policies are subject to change, without notice, at the sole discretion of Mutated Physiques LLC and Member agrees to accept such change as a condition to receiving this membership.

    Mutated Physiques LLC reserves the right to raise dues as needed, at any given time with advance notice, for the growth and prosperity of the Club and its members. At Mutated Physiques LLC, we are committed to keeping our rates as accessible as possible while maintaining the standard of our facility, equipment, and lease. To cover these essential operational costs, regular pricing will undergo a minimal, scheduled annual increase of 3%. Please note that this routine operational adjustment is separate from price changes when promotional or sale pricing transitions back to regular rates.

    Mutated Physiques LLC shall not be liable for loss, theft or damage to the personal property of the Member.


    I 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 trainer has informed me that I am the only responsible party both for any incorrect information provided to the trainer and any injuries during the fitness program. I release and discharge the fitness trainers 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 center authorities immediately.

     

    EXCULPATORY AGREEMENT


    I/we am/are aware that I/we might be injured or sickened while engaging in the following activities: training and stretching, use or misuse of resistance machines, cardiovascular machines and other exercise equipment, from falling either from the fall or due to striking objects while falling, partner practice, aerobic instruction and use of the club amenities.

    I/we understand that there are other hazards not enumerated above which could cause injury.

    I/we am/are aware that there may be images taken for use on the Mutated Physiques LLC website and social media. I/we will make the Mutated Physiques LLC aware if I/we would not like images to be shared.


    The term of this exculpatory clause shall also be binding as to any other persons or members of my family, including minors who accompany me.

    This agreement shall be interpreted and governed by the laws of the State of Connecticut.

    I AM OVER THE AGE OF EIGHTEEN OR AM THE PARENT/GUARDIAN OF THE CLIENT AND I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.

    I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND MUTATED PHYSIQUES AND EMPLOYEES OR AGENTS AND I HAVE SIGNED THIS RELEASE OF LIABILITY OF MY OWN FREE WILL.

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