Health & Wellness
  • Health & Wellness

    Personal Information
  • Birth Date
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Step 2

    Medical / Health
  • What do you consider your diet to be best described as:
  • Please select the reasons you eat (besides hunger).
  • Step 3

    Goals
  • Which are you looking to do
  • Please select the best times you can exercise.
  • What are your goals for training?
  • Please rate your motivational level to do what it takes for reach your goal.
  • Please rate your readiness for change.
  • Step 4

    Cancellation / Late Arrival
  • 🚨MONEY IS TO BE PAID IN FULL🚨 48hrs Prior to first initial Workout. (Payments are NON REFUNDABLE) 

     Cancellations: 

     -SESSIONS-

    Cancellation of your session is non refundable and cannot be rescheduled. Please make sure the day & time you choose is adequate for you. Once your days are confirmed they are locked in and cannot be changed. 

     

    -MONTHLY-

    If you have to cancel your workout day for whatever reason 24 hour notice is required in order to reschedule for a later date within that month you have agreed to. The days you lock in are your days after confirmation. If you miss a day and would like to come in on another day that week it will be considered a squeeze in session of $65, and must be paid before session begins.

     -Last minute cancellation will not be rescheduled!! A $20 fee is required for last min cancellation up to 1 hour before session begins.

     

    Late Arrival:

    -Please arrive on time for your appointment, as failure to do so may result in your appointment being canceled. Arriving late interferes in other clients scheduled time slot. A charge of $10 is required for every 10min you are late.

    -60min SESSIONS: You have a 10min grace period to arrive after your scheduled time. Anything after 10min you will be charged a late fee of $10 and $1 for every min after prior to your workout and will need to be paid upfront before workout begins. 20min late your slot will be canceled and cannot be rescheduled!

  • Release and Acknowledgement

  • I the client, 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 center authorities immediately.

  • WAIVER & RELEASE FORM
    It is my desire to utilize the premises, facilities, and equipment owned by Victoria Fitness located at 444 Broadway, Menands, NY 12204 (hereafter called "Owner").
    I acknowledge that there could be a risk of personal injury in the use of the premises, facilities, classes, and equipment.
    In consideration of the Owner allowing the undersigned user to be on and to utilize said premises, facilities, classes and equipment, I agree to assume the risk of personal injury. I agree to hold harmless the Owner and the employees of Victoria Fitness, as a business and individually, from any and all liability claims, damages, losses, or cause of action, which may be incurred by the user while he/she is on said premises, or while using said equipment or taking any classes. I agree to hold harmless the Owner and the employees of Victoria Fitness for anything that may arise, including, but not limited to, any negligence, any loss arising from theft, or any other reason whatsoever.
    In addition, (if the user is a minor) I hereby grant permission for the user to be on the said premises, and to utilize the facilities and equipment thereon.
    Because physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the trainer or instructor from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. By purchase of ticket, I acknowledge that I understand its content and that this release cannot be modified orally.

  • Date
     - -
  • Should be Empty: