• Online Coaching Client Intake & Agreement

    Please complete this intake form so coaching can be customized to your needs. All information is confidential. This for will take 3-5 minutes to complete.
  • Date of birth*
    Ā -Ā -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Health History / PAR-Q

  • Heart Condition*
  • Chest pain with activity*
  • Dizziness/fainting*
  • High blood pressure*
  • Medications affecting exercise*
  • Recent injury/surgery*
  • Joint/back pain limiting exercise*
  • Pregnancy/postpartum*
  • Do you have medical clearance to participate in exercise if needed?*
  • Goals + Current Activity

  • What are your goals?*
  • What are you interested in? (select all that apply)*
  • What best describes your mindset toward coaching right now?*
  • If we decide we’re a good fit, what level of investment are you comfortable making toward your goals right now?*
  • 🧾 INFORMED CONSENT

    Informed Consent for Exercise Participation
  • I understand that participation in an exercise program involves physical activity that may include, but is not limited to, strength training, cardiovascular exercise, mobility work, and general fitness activities. I acknowledge that these activities carry inherent risks, including muscle soreness, strains, injury, illness, or in rare cases, serious health complications.

    I confirm that I am voluntarily participating and understand that I may stop or modify participation at any time. I agree to communicate any pain, discomfort, medical conditions, or changes in health status to my coach promptly.

    I understand that coaching services are not medical treatment, physical therapy, or rehabilitation, and I am responsible for seeking medical clearance if needed.

  • āš–ļø LIABILITY WAIVER

    Release of Liability
  • I voluntarily assume full responsibility for any risks, injuries, or damages that may occur as a result of participation in coaching services and exercise programming provided by AdaptALISt.

    I hereby release, waive, and discharge the coach from any and all claims or causes of action arising from participation, except where prohibited by law. I understand that results cannot be guaranteed and that my progress depends on my effort, consistency, and adherence to guidance.

    I agree to exercise safely, use appropriate equipment, and notify the coach of any injuries, pain, or health changes immediately.

  • šŸ“‹ COACHING TERMS & AGREEMENT

    Coaching Policies & Client Responsibilities
  • Scope of Services
    Coaching includes customized fitness programming, educational guidance, and general wellness support. Coaching does not include medical diagnosis, treatment, or physical therapy services.

    Communication
    Primary communication will occur via [Facebook messaging, Instagram messaging, text, or email].
    Typical response time is within [24–48 hours] on business days.

    Payment
    Coaching services are billed at the agreed rate and schedule. Services may be paused or discontinued if payment is not received.

    Refund Policy
    Due to the nature of digital coaching and program delivery, all payments are non-refundable unless otherwise stated in writing.

    Client Responsibilities
    The client agrees to:

    Follow programming responsibly
    Communicate injuries, limitations, or concerns
    Maintain a safe training environment
    Take responsibility for their effort and participation
    Intellectual Property
    All programs, materials, and resources provided are for personal use only and may not be copied, shared, distributed, or resold.

    By proceeding with coaching, the client acknowledges that results vary and are dependent on individual effort, consistency, and adherence.

    Ā 

  • šŸ“ø MEDIA RELEASE

    Media & Testimonial Permission
  • I grant permission forĀ AdaptALIStĀ to use my progress data, testimonials, photos, or videos for educational or marketing purposes, including social media, website, and promotional materials.

    I understand that:

    Participation is voluntary
    I may withdraw permission at any time in writing.

  • I have read and agree to the informed consent above.*
  • By signing below, you acknowledge that you have read and agree to all sections of this intake and agreement.

  • Date*
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  • Should be Empty: