• Health & Wellness

    Personal Information
  • Date Of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • 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. Weekends Closed
  • What are your goals for training?
  • Please rate your motivational level to do what it takes to reach your goal.
  • Rate your readiness for change.
  • Step 4

    POLICY
  • 🚨 UPDATED CLIENT POLICY 🚨
    Effective August 1, 2026


    Please review the updated policies below carefully. By booking and/or confirming your sessions, you acknowledge and agree to the following terms.

    PAYMENT POLICY
    Payment must be made in full at least 48 hours prior to your first scheduled workout session.

    All payments are non-refundable.
    ⸻

    SCHEDULED OR UNSCHEDULED SESSIONS

    Once your training days and times have been confirmed, your schedule is locked in and cannot be changed.

    Cancellations are non-refundable and cannot be rescheduled. Please make sure the day and time you select are suitable for your schedule before confirming your sessions.

    Unscheduled sessions are sessions included in your purchased package that have not yet been assigned a specific training day and time. These sessions must be scheduled and completed within the timeframe of your current training month. Any unscheduled sessions that are not scheduled and completed within that timeframe cannot be rolled over into the following month and will be forfeited.

    ⸻
    LATE ARRIVALS
    Please arrive on time for every scheduled session.


    Arriving late may result in your session being reduced in duration.
    Arriving more than 15 minutes late will result in the session being automatically canceled.


    A canceled session due to late arrival will not be rescheduled or refunded.


    ⸻
    NO CALL / NO SHOW (NC/NS)
    Failure to call or show up for a scheduled session is considered a No Call/No Show and is a failure to communicate.


    1st NC/NS: Warning
    2nd NC/NS: $20 NC/NS fee
    3rd NC/NS: $20 NC/NS fee and termination of training services


    Please be mindful that your scheduled time is reserved specifically for you. Failure to communicate and not showing up is a waste of reserved training time.


    ⸻
    SQUEEZE-IN / MAKE-UP SESSIONS
    If you cancel a scheduled session and would like to make up the session in order to complete your 12-session package, a $65 squeeze-in fee will apply.


    If you need to change a scheduled training day or time after your schedule has been confirmed and locked in, a $65 schedule-change fee will apply.


    The applicable fee must be paid before the new session or schedule change is confirmed.


    Thank you for respecting these policies and my time as your trainer. These updates are in place to ensure consistency, fairness, and accountability for all clients.

    Buttaphly Fitness 🦋

     

  • Release, Acknowledgment & Waiver

  • RELEASE & ACKNOWLEDGMENT 

    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.

     

    WAVIER

    VICTORIA FITNESS FACILITY & FITNESS PARTICIPATION

    ACKNOWLEDGMENT

    Victoria Franchise, LLC / Victoria Fitness

    Draft replacement for the uploaded Personal Injury Liability Waiver - attorney review recommended

    This Acknowledgment applies to use of the premises, facilities, classes, and equipment of Victoria Fitness, operated by Victoria Franchise, LLC ("Victoria Fitness"), located at 444 Broadway, Menands, NY 12204.

    1. Voluntary Participation and Known Risks

       Acknowledgment of risk. I understand that exercise and use of fitness facilities involve inherent and other risks, including but not limited to falls, muscle strains, sprains, overexertion, contact with equipment, and other injuries. I voluntarily choose to participate and agree to follow applicable facility rules and safety instructions.

       Personal responsibility. I am responsible for exercising within my own abilities and for informing the trainer or Victoria Fitness staff of relevant limitations, injuries, symptoms, or conditions that may affect my ability to participate safely.

    2. Independent Trainers

       Separate trainer relationship. If I receive personal-training services from an independent trainer or subcontractor at Victoria Fitness, I understand that the trainer may be an independent business and is responsible for the personal-training services that trainer provides, including exercise selection, programming, instruction, and supervision.

       No employee representation. Unless Victoria Fitness expressly states otherwise in writing, an independent trainer is not an employee of Victoria Fitness merely because the trainer provides services at the facility.

    3. Rules and Equipment

       Safe use. I agree to use equipment for its intended purpose, follow posted rules, and promptly report damaged equipment or unsafe conditions to Victoria Fitness.

       Staff authority. Victoria Fitness may require an activity to stop when reasonably necessary to address an apparent safety concern, facility rule violation, or emergency.

    4. Emergency Treatment

    1. Emergency assistance. In an emergency, I authorize reasonable efforts to obtain emergency medical assistance for me. I understand that Victoria Fitness is not responsible for medical expenses except to the extent required by law.

    5. Legal Rights Preserved

    1. No unlawful release. Nothing in this document is intended to release, waive, or limit any claim or liability that cannot legally be released, waived, or limited under New York law.

    2. Severability. If any provision is determined to be unenforceable, the remaining provisions will remain effective to the fullest extent permitted by law.

    6. Acknowledgment

    By signing below, I acknowledge that I have read and understand this document, have had an opportunity to ask questions, and agree to comply with Victoria Fitness policies and safety rules.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: