Women's Small Group Intake Form

Women's Small Group Intake Form

This is a Semi-Private Personal Training Group for women. This group is for beginner, intermediate, and/or advanced levels. The workouts are scaled to the trainees personal fitness level/needs even though it is in a group environment. This program runs on a structured time plan, uses a mobile app to view your workout, log results and communicate data to your coach. Each member of this group is expected to be on time, consistently show up for sessions, become self sufficient in setting up, getting, putting equipment back, and recording their own results in the app. Spots are limited. However, this program may not be a good fit for everyone, or a good starting point for various reasons. This application helps your coach determine if you are a good candidate for this group.
Client Name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex
Height
Weight
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Do you have any current/previous health diseases/issues.
Please state whether you take any medication, if so, list them below.
Do you have any previous/current injuries/surgeries/chronic "aches and pains"?
What is your goal towards training?
Are you currently in a workout routine? If so, what are you doing?
Do you have any previous workout experience? What have you been doing in the past, if so?
We use a variety of equipment. It keeps you learning new things, challenges the body differently and brings variety into the training. Do you have any preferences regarding exercises, exercise equipment? Any equipment we need to avoid due to a physical limitation? Certain exercises can be modified if needed.
How would you rate your current energy level? 1 (low) - 10 (High)
How would you rate your current sleep quality? 1 (low) - 10 (High)
How would you rate your current nutrition adherence? 1 (low) - 10 (High)
How would you rate your motivation level to start an exercise program? 1 (low) - 10 (High)
Are you currently working on nutrition goals? If so, please specifically share.
Share in detail what a normal day of eating would look like.
What do you feel you have success with, now or in the past, when it comes to nutrition?
What do you struggle with, now or in the past, when it comes to nutrition?
The workouts are designed to be 30 minutes. We do our best to contain the workout in that time frame. This requires participants to be at least a few minutes early to warm up following the warm up in your mobile app, set up equipment, clean up equipment in a timely manner. Of course, you will be showed taught/shown all this in your initial sessions, but making the intentional effort to be self sufficient as you continue through the program. Will you commit to being on time, learning how to become self sufficient for a smooth flowing class?
This training requires you to use a mobile app on your phone to view your workout, log your results, and if needed communicate with your coach. You will be shown how to log your results for easy reference when your coach needs to review and plan your next workout. Will you commit to learn how to use the app and log your results in the way you will be shown?
What can I do as your coach to help you achieve success?
Release and Acknowledgement
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.

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.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Client Signature
Should be Empty:

Women's Small Group Intake Form

Release and Acknowledgement