Personal Training application Form

Full Name *

First Name Last Name

Email

example@example.com

Phone Number

Area Code Phone Number

Gender

Male Female

Date of Birth *

Month Day Year

Age

years

Height

in

Weight

lbs

What do you do for a living?

Whats the activity level at your job?

none(seated only) Moderate (light activity such as walking) High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

Rarely A few times a year A few times a month Weekly

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

Yes No

Has anyone of your immediate family developed heart disease before the age of 60?

Yes No

Do any diseases run in your family?

Yes No

Do you suffer from diabetes, asthma, high or low blood pressure?

Yes No

if yes please list:

Are you a current cigarette smoker?

Yes No

Your current diet could be best characterized as:

low-fat low-carb high-protein Vegetarian/Vegan No special diet

Please rate your readiness for change.

What following goals does best fit in with your goals?

Improved health Improved endurance Increased strength Increased muscle mass Fat loss

What is your goal with your training?

Why?

How often are you willing to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary (at least 3x per week)?

Yes No

Have you trained with a personal trainer before?

Yes No

If yes what kind of training did you do:

At what times during the day would you prefer to train?

Morning Mid-Day Afternoon Evening

How often do you want to do Personal Training a week?

Please Choose

What are your expectations on me as your Personal Trainer?

1.) SESSIONS AND SCHEDULING

All training sessions will be provided in person or virtually depending on the client’s preference or purchased package. Each Training session must be scheduled and confirmed on Sundays at 6pm EST.

For Maximum results clients Must dedicate 2-3 times out the week for training, with sessions being 30-60mins in length.

2.) DROP -INS

Drop-In sessions MUST be scheduled a week in advance and payment will be due before any scheduling is made. Drop-in sessions cannot be grouped together. Each person MUST pay individually for their session.

3.) CANCELLATIONS

Cancellations MUST be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will result in a $15 cancellation fee + the cost of your scheduled session.

4.) LATE ARRIVALS

Each session will be about 30-60 minutes in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

5.) PAYMENTS

Payments will be due before the clients training session, No Late Payments will be accepted. If a payment arrangement is in place that arrangement must be fulfilled in the allotted time frame.

If payment is not received no training sessions will be scheduled in advanced for the client and the client’s contract will be terminated!

6.) REFUNDS

There will be NO refund of services under any circumstances.

7.) CONFIDENTIALITY

Your personal information will be kept confidential. Any pictures or videos taken during sessions will not be shared for marketing purposes without your consent of this terms and agreements contract

8.) TERMINATION

If the client wishes to make any cancelations to their sessions or plan. He/she must give a 14-day notice via email or written letter.

Health and Fitness Liability Waiver & Informed Consent

The information entered is a part of a Health and Fitness program offered through Bre'elle Hamilton, Certified Personal Trainer. This program may involve strenuous physical activities including but not limited to, muscle strength and endurance training, Cardiovascular conditioning and training, weight loss management and other fitness activities.

Straight Fitnessin Inc. is not responsible for any conditions that may include but not limited to heart attack, muscle strains, muscle pulls muscle tears, broken bones, shin splints, heat prostration, injuries to the neck and back, injuries to the upper and/or lower body or any other illnesses or soreness that may incur, including death.

Your results are based on your work ethic,

The harder you work the more results you will see!

I AGREE TO THE ABOVE TERMS & CONDITIONS! *

Yes No

Part 1. Basic information

Personal Training Consultation Questionnaire

Part 2. Lifestyle Information

Part 3: Medical and health information

Part 4: Goals

Please Read The Following Terms and Conditions.