Apply For Coaching

Client Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Email

example@example.com

What’s your Instagram handle? (If you have one)

example@example.com

How would you rate your current nutrition?

0 is Poor, 5 is Excellent

What is your rating for how serious you are to make a change.

0 is Poor, 5 is Excellent

What’s your current workout setup?

How often can you exercise per week?

How much accountability do you feel you need?

What are you wanting to get from this?

I, {clientName}, 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.

Andy 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 Andy 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 Andy immediately.

Date

Client Signature

Apply for Coaching

Release and Acknowledgement