PAR- Q

PAR-Q

IMPORTANT! You MUST fill in all the information on this form. This allows us to provide you with the best results possible!
1. Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Program Length Signed Up For:*

12 Week Program16 Week ProgramOnce off meal plan & training program6 Month
How did you hear about AP-Elite and come to being a client?*

I follow Ashton on InstagramInstagram AdFacebook AdReferralI saw Ashton's posts on another Instagram page I followOther
Country (Location)?*
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Address: This is for your welcome gift delivery*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Weight*
Height*
3. Age*
Date of Birth

MonthDayYear
Date
4. Gender*
5. Has your doctor ever said you have a heart condition?*
6. Do you feel pain in your chest when you do physical activity?*
7. In the past month, have you had chest pain when you were not doing physical activity?*
8. Do you lose your balance because of dizziness or do you ever lose conciousness?*
9.Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
10. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
11. Do you know of any other reason you should NOT be doing physical activity?*
12. Do you suffer from high or low blood pressure?*
13. Are you troubled by any kind of hernia?*
14. Do you suffer from any kidney problems?*
15. Have you ever had any complications with your thyroid?*
16. Do you suffer from high cholesterol?*
17. Do you suffer from hypoglycemia or hyperglycemia (diabetes)?*
18. Do you or have you ever suffered from anemia?*
19. Are you currently suffering from flu or any infection?*
20. Do you suffer from any exercise-induced asthma or any pulmonary disease?*
21. Do you suffer from regular headaches or migraines?*
22. Do you have a history of epilepsy?*
23. Do you suffer from arthritis?*
24. Have you ever had malaria*
25. Do you have a history of rheumatic/tick-bite/glandular fever?*
26. Are you or do you think you might currently be pregnant?*
27. What is the frequency of your bowel movements?*

2- 3 times a dayOnce a day3- 4 times a week2-3 times a weekonce a weekOther
IMPORTANT! If you answered YES to one or more questions in the above PAR-Q, you MUST consult with a licensed physician prior to taking a fitness test, changing your physical activity or changing your diet, dietary supplements or lifestyle in any way! By continuing with this consultation form, accessing this site/application or making use of any services, content, advice or guidance, you expressly warrant that you have consulted with a licensed medical professional and have been cleared for participation in the services you have contracted your affiliated trainer or professional to provide. Your use of this site/training platform and any content, information, advice or guidance provided here through is completely AT YOUR OWN RISK.
General
28. What is your occupation?*
29. what is your level of stress? (0- relaxed, 10- extremely stressed)*
30. Are you currently using any dietary Supplements? Please list.*
31. Have you had a medical or biokinetic (body movement) assessment recently? If so, are there any noteworthy results or health factors your trainer needs to know about? Please specify.*
32. We love to showcase our clients’ results. Are you willing to have videos of your training or progress pictures used in social media campaigns, if we ask your permission first?*

YesNo
Goals and Exercise History
33. What are your fitness goals? You can select more than 1.*

Lose fatLose fat + toneLose fat + increase muscleIncrease muscle mass (bulk)General healthOther
34 Any Notes to add to your above goals?*
35. Do you exercise regularly?*

YesNo
36. If you currently exercise regularly, how often do you exercise?*
38. Rate your overall activity level? (0- not at all active, 10- extremely active)*
39. Rate your ability to perform cardio exercise. (0- not able, 10- able to perform at high levels of cardio.)*
40. Rate your experience with exercise*

BeginnerIntermediateConfident
INJURIES AND MEDICAL HISTORY
41. Do you have any existing/past injuries, contra-indications or medical conditions that a trainer should be aware of while building your training plan, please explain?*
42. If so, when did the injury take place?
43. Have you fully recovered from the injury and do you feel that it would restrict your training at all?
44. Have you had any operations or medical procedures? Please specify.*
45. Do you currently take any medications? If so, please list.*
Is there a history of any health conditions in your family? *
Please list any food allergies/in-tolerances you may have. Include any religious food restrictions.*
46. Do you drink alcohol?*

YesNo
47. If so, how much/how often?
48. Do you smoke tobacco products?*

YesNo
49. If so, how much/how often?
50. Do you know your fasted glucose or lipid profiles? If so, please specify.
51. If you are a woman - are you pregnant, suspect you may be pregnant or are attempting to fall pregnant now or in the near future?*
TRAINING PROGRAM DESIGN
Which of the following best describes you?*

I like to push myself hard and love working up a sweat, feeling my muscles burn and getting my heart rate up. I am self-motivated but I need guidance to train effectively.I enjoy working out but sometimes I need to dig deep to complete a workout. When it gets hard, I find it difficult to keep pushing myself. I need someone to hold me accountable.I don’t enjoy exercise even though I know it’s good for me and I need to do it. I need someone to tell me what to do and I need to be motivated to get into a routine
What sort of workouts have you done in the past that you really enjoyed? If you are currently doing any workouts that you would like to include in your schedule, please list them below and include which days of the week.*
Is there any sorts of exercise that you really do not enjoy?*
52. What time do you generally wake up?*
54. What time of day do you train or plan to train?*
How many days a week are you willing to workout?*

345-7
Please tick the days below that you WOULD like to workout on:*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
How many minutes/ hours would you prefer to workout on these days?*
55. What equipment do you currently have access to? Please specify type and weight ranges of the equipment you have *
If required, which of the following equipment would you be willing or able to purchase? This is not compulsory*

Balance ball (roughly $15- $20)Theraband (roughly $10)Resistance bands (roughly $25)None of the above
56. In your opinion, what are the greatest weaknesses you would like to focus on, and what are your greatest strengths?*
Meal Plan Preferences
Please upload a RECENT full length picture of yourself. This is not your actual "before" pictures but rather just a general picture for us to just get a general idea of current body composition

Browse Files

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The below picture of foods is only here to spark your memory in terms of your food preferences and does not represent the only foods that will be used in your meal plan. So, take a few moments to have a look at the food groups to help you answer the next questions.
Which of the following best describes the way you would like to eat:*

I would like to only eat fresh, whole types of food.I would mainly like fresh, whole, organic types of food but don't mind some processed foods here and there for convenience. Examples would include off the shelf canned or bottled items.I don't mind a mixture of both, convenience is key
Please select any of the below foods that you will NOT eat:*

BeefPork/ baconLambVealChickenTurkeySalmonTunaTilapiaSardinesTrout & SnapperShell fishHoneyMayoTofuSoy milkBreakfast cerealsPastasBreadRiceOatmealSugarBeansLentilsPeasPotatoes & yamsCornArtichokesAsparagusBeetsBroccoliCarrotsSproutsCeleryPeppersTomatoesEggplantsAvocadoPeanutsAlmondsWalnutsPecansMilkCreamCheeseYogurtCottage cheeseWhey powderAppleBananaGrapesOrangeStrawberriesRasberriesBlueberriesFruit juice
58. What foods/ meals do you enjoy eating throughout the work week?*
What foods/meals do you enjoy eating over the weekend? Yes, you can include anything here :)*
59. What meal types would you prefer avoiding?*
When you think of your ideal meal structure which of the following best describes your needs*

Maximum variety of foodsSimplicityConveniencecost effectiveOther
As a standard, we usually give you a 7 day meal plan with maximum variety however, I know this can be a little overwhelming to meal prep for and does also increase the number of ingredients on the grocery list. Choose from the options below that you feel are the most realistic for you to manage*

I want full 7 maximum variety to choose from.3 days will be easier for me to rotate between.3 days would work best for me with an additional weekend day to mix things upOther
When would you prefer to eat a snack?*

Between breakfast and lunchBetween lunch and dinnerAfter dinner
Is there any additional requests you may have for us to consider when designing your meal plan? For example, simpler meals for lunch, certain types of breakfasts you enjoy, leftovers from dinner for lunch the next day to make meal prepping easier for the next day, anything along these lines.*
Please indicate which days of the week and what time in your day would work best for your weekly check in calls. Please include your timezone. Calls are roughly 20- 30 min. *
Supplementation
60. Are you willing to utilize dietary supplements to achieve your goals? NOTE: Any supplements you utilize are completely at your own risk.*
61. Please specify any current supplements you are taking as well as which ones you would like to continue to use. Dietary supplements in part as products taken by mouth that contain a "dietary ingredient." Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet like protein powders, for example.*
Please upload the front and back (nutritional information) of the supplements you would like to continue to use.

Upload pictures here

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62. Are you aware of any supplements that you are adverse to, or that may not be safe for you to take? Please specify.*
63 Is there anything note worthy in relation to your health or nutrition that will assist us is setting up you eating plan that is noteworthy, that you would like to add? Please take your time to think about this, if you are not sure if it is relevant or not, rather put it down here.*
By signing this document you confirm that the information in this form is comprehensive and complete and you understand and agree that the recommendations that will be made in relation to your nutrition and exercise regiment, will be based on the information provided. Should any of the details on this document change, you will need to update us so that we may make any necessary changes to your training or nutrition.

By utilizing AP- Elite services, you acknowledge that meal plans issued are not aimed to diagnose, treat, prescribe or cure any medical conditions. The meal plans issued are to guide and provide advice to compliment and support your fitness goals solely. By signing below, you acknowledge that you understand that AP- Elite meal plans are recommendations and advice only and that you should seek the advice of a registered dietician or doctor if you feel you have a medical condition to diagnose, prescribe or treat any nutritional based issues.

General Statement of Program Objectives and procedures: 

I understand that this personal training program may include exercises to build the cardiorespiratory system (heart and lungs), the musculoskeletal system, (which involves muscular endurance, strength and overall flexibility), and to improve body composition (increasing muscle and bone density and decreasing body fat). Exercise includes aerobic activities, such as walking, running, bicycle riding, rowing machine, group aerobics, swimming and other aerobic activities, weight lifting using dumbbells, machines and other equipment to improve muscular strength and endurance, as well as flexibility exercises to improve range of motion.

Description of Potential Risks: 

I understand that the reaction of the heart, lung, blood vessels as well as other systems to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during the following exercise, which include abnormalities of blood pressure or heart attacks as well as other side effects. Use of weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not consistently followed. I understand that personal trainer (seller) shall not be liable for any damages arising from personal injuries sustained by client (buyer) while and during and/or from a personal training program does so at his/her own risk. Client (buyer) assumes full responsibilities for any injuries or damages which may occur during and/or after training. I hereby fully and forever release and discharge personal trainer (seller), its assigns and agents from all claims, demands, damages, rights of action, present and future therein. I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate (other than those items fully discussed on the health history form). I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the activity.
I am fully aware of the risks and hazards connected with physical activities and exercise in general, and I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to me. I voluntarily assume full responsibility for any risks of loss or personal injury, including death, that may be sustained by me, as a result of being engaged in such an activity, WHETHER CAUSED BY THE NEGLIGENCE OF AP-Elite or otherwise, to the fullest extent allowed by law.

Description of Potential Benefits:

I understand that a program of regular exercise for the heart, lungs, muscles and joints has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function and decrease in heart disease. I have read the foregoing information and understand it. Any questions, which may have occurred, have been answered to my satisfaction.

Payment:
Payment is due in full at the time of commencement of the program. In the event that payment is not received in full at the commencement of the program, due to an arrangement between us and you, then all payments must be received as agreed upon in your payment plan. Any unpaid balances will incur a 10% late fee if not paid within 5 days of their due date.

Refund Policy:
Your custom program in non-refundable. A great deal of work, time, and resources go into the initial planning and design of your custom programs. If you fall ill/ injured, your program will be put on pause for up to 180-days, after which point your program will be deemed to be completed in the event you do not return

Money Back Guarantee:
Our goal is to give you results, but results require effort on both of our ends. To receive a money back guarantee, you must stick to your outlined program for at least 6 weeks. This includes participating in all weekly consulting calls with your dedicated success coach and following our guidance regarding exercise and diet for at least 6 weeks. If at the 7-week mark, you are unsatisfied with the program results, and the program did not result in a physical change, a full-refund will be issued. To be eligible for the refund, you must fully participate in the program prior to the termination date. Full participation includes but is not limited to:

Measurements and weight must be uploaded weekly for assessment
Must submit weekly feedback form
Must attend ALL weekly check- in calls with Success coach

Client agrees not to request, advise, file a claim, or seek Client’s bank or credit card company for a chargeback for consideration paid under this Agreement. Client agrees to waive any rights Client may have under applicable state and federal truth in lending laws or otherwise (including, but not limited to, under Client’s credit card issuer’s procedures for resolving such disputes). Client agrees that any disputes that Client may have with respect to consideration paid hereunder must be addressed directly between Client and AP- Elite LLC.
If a chargeback occurs, Client shall have materially breached the Agreement and shall forfeit all remaining services that have not yet been performed under the Agreement. AP- Elite LLC shall have no further obligation to Client. Further, the amount of the chargeback shall be subject to a finance charge in the amount of one- and one-half percent (1 ½%) per month until paid in full by Client. Further, AP- Elite shall be entitled to recover from Client all damages, and reasonable and necessary attorneys’ fees, and costs associated with pursuing collection and/or recovery of the amount of the chargeback.

Payment Plan Authorization:

If the Client has been granted a payment plan for the services rendered, they hereby authorize AP- Elite LLC to automatically deduct the additional payments from the same credit card used for the initial payment. By signing this contract, the Client gives explicit permission for AP- Elite LLC to process these subsequent payments using the provided credit card details.

This authorization ensures a smooth and hassle-free payment process for both parties, allowing the Client to fulfill their financial commitment without the need for manual payment arrangements. AP- Elite LLC will maintain the utmost security and confidentiality in handling the credit card information and will only use it for the specified purpose as described in this contract.

By signing below, the Client acknowledges and agrees to the automatic deductions for the agreed-upon payment plan and affirms that they have read and understood the terms of this authorization.

Disclaimer:
AP-Elite fitness does not employee physicians or dieticians. None of the fitness consultants providing services related to the program will be a physician or a licensed dietician. The advice provided as part of the program is a reflection of what has worked with other clients and is based on real life experiences of our trainers. Results are not guaranteed. Each client will experience weight loss and fitness gains unique from other clients. We are here to guide you on your fitness journey, to act as a form of accountability and to provide you with support and assistance in creating a roadmap for long-term success.
Indemnification and Hold Harmless:
I agree to indemnify and hold AP-Elite, its affiliates and contractors harmless from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney's fees brought as a result of my involvement with the program and to reimburse them for any such expenses incurred.
Severability:
The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as permitted by the law of the State of Wyoming, or any other applicable jurisdiction, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding:
I have read this waiver of liability, the assumption of risk, and indemnity agreement, terms of the program and fully understand the terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing freely and voluntarily, I represent that I have provided factually accurate information, and intend by my signature to bring about a complete and unconditional release of all liability to the greatest extent allowed by law.
Attorney’s Fees: 
In the event of breach of this agreement, including any of the payment terms, by Client, AP-Elite shall be entitled to reimbursement of all of its costs and expenses, including reasonable attorneys’ fees, incurred in connection with such dispute, claim or litigation, including any appeal thereof.

Miscellaneous:

This agreement, including any other documents specifically incorporated by reference, sets forth the entire agreement between Ap-Elite and client with respect to the subject matter hereof and supersedes all previous representations, understandings or agreements and shall prevail notwithstanding any variance with terms and conditions of any other prior writing between the parties. The waiver by either party hereto of any breach of the terms and conditions hereof will not be considered a modification of any provision, nor shall such a waiver act to bar the enforcement of the subsequent breach.
Signature*

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PAR-Q

General

Goals and Exercise History

INJURIES AND MEDICAL HISTORY

TRAINING PROGRAM DESIGN

Meal Plan Preferences

Supplementation