Personal Training Application Form

Part 1. Basic information

Body Sculpting
Email
example@example.com
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Gender
Date of Birth

MonthDayYear
Age
years
Height
Weight
LB
Target Weight
LB
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Medical and health information
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?
Has anyone of your immediate family developed heart disease before the age of 60?
Do any diseases run in your family?
Do you suffer from diabetes, asthma, high or low blood pressure?
(Women) Are you experiencing menstral irregularities?
if yes please list:
Are you a current cigarette smoker?
Your current diet could be best characterized as:
Part 4. Goals
Please rate your readiness for change.
Which of the following best align with your goals?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

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 exercising regularly (at least 3x per week)?
Have you trained with a personal trainer before?
If yes what kind of training did you do:
At what times during the day would you prefer to train?
How often do you want to do Personal Training a week?
Please Choose
What are your expectations of me as your Personal Trainer?
Please Read The Following Terms and Conditions.
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour 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.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I agree, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with Legacy Fit3.

Having such knowledge, I hereby release Legacy Fit3, their representatives, agents, and successors from liability for accidental injury or illness, which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in said fitness program.
Liability
I AGREE TO THE ABOVE TERMS & CONDITIONS!
Should be Empty:

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following Terms and Conditions.

Liability