• Vitalice Fitness & Wellness Consultation and Intake Form

    Vitalice Fitness & Wellness Consultation and Intake Form

    Consultation form for training services from Issah Traylor
  • Who is receiving training?*

  • General Info

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Birthday*
     - -
  • Gender*
  • How should I contact you? (Parent/Guardian)*
  • How should I contact you?*
  • Format: (000) 000-0000.

  • Goals/Lifestyle

  • What are your athlete's primary goals? Select all that apply*
  • What are your primary goals? Select all that apply*
  • How often does your athlete work out?*
  • How often do you work out?*
  • What is your diet like?*
  • How many hours of sleep do you get per night*

  • Medical / Safety

  • Do you have any current injuries, medical conditions, or physical limitations? (Ex: asthma, sprains, arthritis, scoliosis, diabetes etc.)*
  • Are you currently taking any medications that could affect exercise or physical activity?*
  • Has a doctor cleared you to participate in physical activity/exercise?*

  • Liability Waiver & Program Agreement

  • Assumption of Risk

  • I, the parent/guardian of the participant listed above, understand that participation in Vitalice Fitness & Wellness training services involve physical activity, including but not limited to strength training, weightlifting (including squats, presses, curls, deadlifts, and Olympic lift variations), sprinting, jumping, and other athletic movements and exercises.

    I acknowledge that these activities carry inherent risks, including but not limited to muscle strains, sprains, injury, illness, or in rare cases, serious injury.

    I voluntarily assume all risks associated with my child’s participation in these training services and programs.

  • I, understand that participation in training Vitalice Fitness & Wellness training services involve physical activity, including but not limited to strength training, weightlifting (including but not limited to squats, presses, curls, deadlifts, and Olympic lift variations), sprinting, jumping, and other athletic movements and exercises.

    I acknowledge that these activities carry inherent risks, including but not limited to muscle strains, sprains, injury, illness, or in rare cases, serious injury.

    I voluntarily assume all risks associated with my participation in these training services and programs.

  • MEDICAL CLEARANCE & RESPONSIBILITY

  • I certify that my child is physically able to participate in this program and has no medical conditions that would prevent safe participation, or I have disclosed all relevant medical conditions, injuries, or limitations in this form.

    I understand that it is my responsibility to inform the coach of any changes in my child’s health, injury status, or physical condition.

  • I certify that I am physically able to participate in these services and have no medical conditions that would prevent safe participation, or I have disclosed all relevant medical conditions, injuries, or limitations in this form.

    I understand that it is my responsibility to inform the coach of any changes in my health, injury status, or physical condition.

  • Release of Liability

  • In consideration of being allowed to participate in these services, I hereby release, waive, and discharge the coach(es), trainer(s), and any affiliated facilities and persons from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury that may be sustained while participating in the program.

    This includes, but is not limited to, injuries caused by negligence, equipment use, or participation in training activities.

  • In consideration of being allowed to participate in training services and programs, I hereby release, waive, and discharge the coach(es), trainer(s), and any affiliated facilities and persons from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury that may be sustained while participating in services.

    This includes, but is not limited to, injuries caused by negligence, equipment use, or participation in training activities.

  • PROGRAM STRUCTURE & PARTICIPATION AGREEMENT

  • I understand that this is a structured, progressive training program, and that each session builds upon the previous sessions.

    I acknowledge that:

    • Sessions are to be attended consistently

  • Media Release Form

  • I grant Vitalice Fitness & Wellness permission to photograph or record my child during training sessions for educational and promotional purposes.*
  • I grant Vitalice Fitness & Wellness permission to photograph or record me during training sessions for educational and promotional purposes.*
  • How did you hear about us?*

  • Code of Conduct

  • I understand that all participants are expected to:

    • Follow instructions from the coach

    • Respect others in the program

    • Use equipment safely and appropriately

    • Participants should show up/dropped off and picked up on time.

    Failure to follow these guidelines may result in removal from training services.

  • ACKNOWLEDGMENT & CONSENT

  • By signing below, I acknowledge that I have read, understood, and agree to all terms outlined in this waiver and agreement.

    I voluntarily consent to my child’s participation in the Summer Strength & Performance Program.

    These Terms & Conditions apply to all services provided by Vitalice Fitness & Wellness, a brand of Vitalice Enterprises LLC, operated by Issah Traylor.

  • By signing below, I acknowledge that I have read, understood, and agree to all terms outlined in this waiver and agreement.

    I voluntarily consent to participation in training services and programs administered by Vitalice Fitness & Wellness.

    These Terms & Conditions apply to all services provided by Vitalice Fitness & Wellness, a brand of Vitalice Enterprises LLC, operated by Issah Traylor.

  • Date signed*
     - -

  • Payment

    Select one of the two options to book consultation

  • Select one of the two payment options to secure booking.

  • 1. Cash App Pay (in notes, put your first and last name and "Consultation")

    2. Square Pay

     

  • Schedule Consultation Appointment*

  • Consultation Booking Terms & Conditions

  • Consultation Requirement

    A consultation is required before booking any personal training services. If a personal training session is booked before completing a consultation, $35 of the payment will be applied toward the required consultation. Any remaining balance may either be refunded or applied toward an official personal training session following the consultation.

    Securing Your Consultation
    You must complete the entire intake form AND submit payment in order for your consultation appointment to be secured.

    No completed form = appointment is not secured.
    No payment = appointment is not secured.

    If the intake form is not completed and payment is not received within 24 hours of your scheduled appointment, the appointment will be canceled and you will need to reschedule.

    Payments for appointments canceled due to an incomplete intake form or failure to submit payment are non-refundable, as the reserved time could have been made available to another client.

    Cancellations & Rescheduling
    If a scheduling conflict arises, please provide at least 24 hours' notice to cancel or reschedule whenever possible.

    If an unexpected conflict arises, please contact Vitalice Fitness & Wellness as soon as possible so we can determine the best way to proceed.

    Scheduling Conflicts on the Trainer's End
    If a scheduling conflict occurs on the trainer's end, Vitalice Fitness & Wellness will contact you as soon as possible to reschedule your appointment.

    If a mutually convenient date and time cannot be arranged, you will be offered the choice of a full refund or having your payment applied toward a future consultation or session.

    Late Arrival
    If you arrive late to your scheduled appointment, you will receive only the remaining time available within your originally scheduled appointment. The full appointment fee will still apply.

    If you are 15 minutes or more late, your appointment will be considered canceled and no-show. Your payment will be non-refundable, unless otherwise determined by Vitalice Fitness & Wellness.

     

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