Client Inquiry

Name

First NameLast Name

Instagram and/or Facebook name?

Age

Date of Birth

Date

Gender

Email

example@example.com

Phone Number

Area CodePhone Number

Emergency Contact Person

First NameLast Name

Phone Number of Emergency Person

Area CodePhone Number

Weight (lbs)

What type of fitness are you interested in?

Do you have the following conditions?

Are you pregnant (Female only)?

What are your goals in this program?

Goals - please be specific

Any physical limitations?

All times above may not be available: What days & times works best for you? (in-person only, if virtual don’t pick times) All class are 55 mins and videos are on website for viewing www.FitnessVibes757.com

Other

What is the biggest challenge that can keep you away from your fitness goals?

Start date requested?

Date

Please upload 3 "BEFORE" pictures (example above) If you don’t have fitness wear, send me some for reference in what you have. Pictures are mandatory, this helps both of us guide you through your journey (any issues please dm or text 757-375-3436

Browse Files

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 that I am voluntarily participating in using physical activity with Fitness Vibes 757.

Having such knowledge, I hereby release Fitness Vibes 757, 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/agreed fitness program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in Fitness Vibes 757 exercise programs.

*Please sign in agreement to the above liability waiver*

Client Signature- Pictures are required, if you want to send immediately, send some regular pics that shows your body type from your Instagram Or Facebook. There are no refunds for payments made once starting the program.

Date Signed

Date

Browse Files