PERSONAL TRAINING AGREEMENT PERSONAL TRAINING AGREEMENT NAME:___________
NAME:_______________________________________________________________________________ HOMEADDRESS:_______
HOMEADDRESS:_________________________________________________________________________________________________
HOME/WORK/CELL
HOME/WORK/CELL PHONE:______________PHONE:______________________________________________________________________________ EMAIL
EMAIL ADDRESS: ADDRESS: ____________________________________________________________________ TRAINING SESSION
TRAINING SESSION START DATE: ___________________START DATE: ___________________ TRAINING RATE
TRAINING RATE ______________________________________
Terms and Conditions for Personal Training: Terms and Conditions for Personal Training: 1.
1. Payment Payment in in full is full is required prior required prior to to each each training session. training session. Payment methodsPayment methods accepted:
accepted: Cash, Money OrderCash, Money Orderandand ChecksChecks. A. Aservice charge of $25service charge of $25will bewill be
assessed for any returned checks. After two returned checks the client will be asked to assessed for any returned checks. After two returned checks the client will be asked to conduct their payment in the form of
conduct their payment in the form of CashCashororMoney OrderMoney Orderonly.only. 2.
2. An initial An initial screening/consuscreening/consultation may ltation may be be required prior required prior to starting to starting the Personalthe Personal Training Program if more than one year has passed since the last screening (Physical Training Program if more than one year has passed since the last screening (Physical Exam by your Physician/Fitness Assessment by a qualified Personal Trainer).
Exam by your Physician/Fitness Assessment by a qualified Personal Trainer). 3.
3. If you If you are late for are late for a session it a session it will result in lost will result in lost training time unless arrangementstraining time unless arrangements can be made with the trainer to make up for the time missed.
can be made with the trainer to make up for the time missed. 4.
4. A 2-hour notice must be given to the trainer to cancel a session. Failure to do soA 2-hour notice must be given to the trainer to cancel a session. Failure to do so will require the client to pay
will require the client to pay the full amount for the session the full amount for the session missed. missed. If two orIf two or more cancellations occur within a 30-day period, the client will be charged for more cancellations occur within a 30-day period, the client will be charged for each of these missed sessions regardless of notification
each of these missed sessions regardless of notification (Please make sure you(Please make sure you verbally have spoken with the Personal Trainer and if the Trainer is
verbally have spoken with the Personal Trainer and if the Trainer is
unavailable at the time of your call please leave a detailed message so that unavailable at the time of your call please leave a detailed message so that he/she can contact you).
he/she can contact you). *Participants with the monthly packages will have *Participants with the monthly packages will have 22 weeks to make up a
weeks to make up a cancelled session or it will be lost.cancelled session or it will be lost. 5.
5. Money will not be refunded on unused sessions regardless of the reason that theMoney will not be refunded on unused sessions regardless of the reason that the sessions were not used.
sessions were not used. 6.
6. You have up toYou have up to 30 days30 daysto complete all sessions with each number sessionto complete all sessions with each number session package of purchase
package of purchase (It is beneficial that you are (It is beneficial that you are consistent with your sessionsconsistent with your sessions in order to get/receive the positive results from your designed exercise
in order to get/receive the positive results from your designed exercise program.
program.In exception to the monthly package participants, you have up to 14In exception to the monthly package participants, you have up to 14 days). Monthly package participants can freeze their training sessions due to days). Monthly package participants can freeze their training sessions due to medical reasons, work travel related incidents or if going on vacation with at least medical reasons, work travel related incidents or if going on vacation with at least a 2 week notice.
7.
7.How Monthly Packages Breakdown:How Monthly Packages Breakdown:1x a Week=4 Sessions a month; 2x a1x a Week=4 Sessions a month; 2x a Week=8 Sessions a month and 3x a Week=12 Sessions a month. For the months that Week=8 Sessions a month and 3x a Week=12 Sessions a month. For the months that have extra weeks, these days are used as makeup days or fitness homework is given to have extra weeks, these days are used as makeup days or fitness homework is given to the participant that must be completed.
the participant that must be completed.
I fully understand the terms and conditions stated above, and agree to adhere to the them I fully understand the terms and conditions stated above, and agree to adhere to the them without deviation or exception.
without deviation or exception. I acknowledge that I have I acknowledge that I have received a copy of received a copy of thisthis Agreement.
Agreement. Client
Client Signature: Signature: ________________________________________________ ____________ Date: Date: __________________________
Personal Trainer Signature: ____________________________ Date: _____________ Personal Trainer Signature: ____________________________ Date: _____________
PERSONAL TRAINING QUESTIONNAIRE PERSONAL TRAINING QUESTIONNAIRE 1.
1. Have you Have you worked with a trainer worked with a trainer in the past?in the past?
a.
a. How long How long did you did you train?train?
2.
2. Do yDo you ou have a have a trainer preference trainer preference (Male/Femal(Male/Female, e, Age, etc.)?Age, etc.)?
3.
3. Day Day and and Time Time Preference.Preference.
4.
4. What What are are your your fitness fitness goals?goals?
5.
5. Are you Are you currently exercising currently exercising on on a a regular basis?regular basis?
a. What type of cardio do you do? a. What type of cardio do you do?
b. What type of strength training? b. What type of strength training?
6.
6. If you If you are not are not currentlcurrently y exercising, what type of exercising, what type of exercise have you exercise have you done in the done in the past?past?
7.
7. Are there Are there any any special needs special needs or circumstances the or circumstances the trainer should trainer should be aware be aware of that of that maymay affect you during exercise?
affect you during exercise?
8.
8. Have Have there there been been any any significant changes significant changes in in your your health health history history since ysince you ou completedcompleted your last physical exam?
your last physical exam?
If yes, please explain. If yes, please explain.
PERSONAL TRAINING HEALTH QUESTIONNAIRE PERSONAL TRAINING HEALTH QUESTIONNAIRE
This form is to help us determine your readiness to begin a Personal Training This form is to help us determine your readiness to begin a Personal Training Program. Information that you provide on this form will be maintained in a confidential Program. Information that you provide on this form will be maintained in a confidential manner and disclosed only to the Fit2Be Fitness Staff. With your authorization, it may manner and disclosed only to the Fit2Be Fitness Staff. With your authorization, it may also be provided to your Physician(s) should your answers indicated Physician's
also be provided to your Physician(s) should your answers indicated Physician's Recommendations are necessary.
Recommendations are necessary.
Name: __________________________________________________________ Name: __________________________________________________________ Date
Date of of Birth:_____Birth:____________ _______ Age:_______ Age:_______ Sex: Sex: M M / / FF
Please complete this form to the best of your knowledge:
Please complete this form to the best of your knowledge: YesYesororNoNo 1.
1. Have you Have you had a had a Heart Attack, Heart Attack, Stroke, Chest Stroke, Chest Pain, or Pain, or Heart Surgery? Heart Surgery? Please specifyPlease specify 2.
2. Has yHas your our doctor doctor said that said that you you have have Cardiovascular, Pulmonary, Metabolic Cardiovascular, Pulmonary, Metabolic or or otherother significant disease?
significant disease? 3.
3. During or During or right after right after exercise, do yexercise, do you haou have pains ve pains or or pressure in pressure in the Chest the Chest area, Neck,area, Neck, Shoulder or Arm?
Shoulder or Arm? 4.
4. Have yHave you ou experienced any experienced any unusual Leg unusual Leg pain upon pain upon exertion?exertion? 5.
5. Has your Has your doctor said doctor said that you that you have a have a Heart Murmur Heart Murmur or Irregular or Irregular Heart beat?Heart beat? 6.
6. Do yDo you ou have Ihave Insulin-Depennsulin-Dependant dant Diabetes or Diabetes or take Medication take Medication to to control ycontrol your bloodour blood sugar?
sugar? 7.
7. Do yDo you experience ou experience Shortness of Shortness of Breath at Breath at rest or rest or with mild with mild exertion?exertion? 8.
8. Has your Has your doctor said doctor said you you have High have High Blood Pressure Blood Pressure (140/ 90) (140/ 90) or are or are you you onon Medication for your blood pressure?
Medication for your blood pressure? 9.
9. Do Do you you experience experience Dizziness/FaintDizziness/Fainting ing Spells Spells at at rest rest or or with with exertion?exertion? 10.
10. Are you Are you currentlcurrently Py Pregnant or within six regnant or within six weeks Postpartum? (# of weeks Postpartum? (# of months pregnant)months pregnant) 11.
11. Are you Are you are currently taking Prescription Medication for an are currently taking Prescription Medication for an underlying disorder?underlying disorder? 12.
12. Do you have Do you have a Chronic or Acute Orthopedic or a Chronic or Acute Orthopedic or other health condition that you orother health condition that you or your physician feel will be affected by or affect your exercise (i.e. Bursitis, Arthritis, your physician feel will be affected by or affect your exercise (i.e. Bursitis, Arthritis, Neck or Back Injury, Past Surgery, etc.)? Please specify.
Neck or Back Injury, Past Surgery, etc.)? Please specify. 13.
ability to participate in an exercise program (i.e. Seizures, Epilepsy, Emphysema, ability to participate in an exercise program (i.e. Seizures, Epilepsy, Emphysema, Asthma, etc.)? Please specify
Asthma, etc.)? Please specify 14.
14. Do you Do you have a male have a male family member under the family member under the age of age of 55 OR a 55 OR a female familyfemale family member under the age of 65 who has a history of Cardiovascular Disease, such as member under the age of 65 who has a history of Cardiovascular Disease, such as Heart Disease, Stroke, Angina (chest pain), High Blood Pressure, etc.? Please Heart Disease, Stroke, Angina (chest pain), High Blood Pressure, etc.? Please specify.
specify. 15.
15. Are you Are you a male a male over the over the age of age of 45?45? 16.
16. Are you Are you a female over a female over the age of the age of 55, or Post 55, or Post Menopausal, or had Menopausal, or had a Hysterectomy?a Hysterectomy? 17.
17. Do yDo you consider ou consider yourself more yourself more than 20 than 20 lbs. overweight?lbs. overweight? 18.
18. Is your Is your total Serum Cholesterol total Serum Cholesterol >200 mg/di >200 mg/di and/or have yand/or have you been ou been diagnosed withdiagnosed with High Cholesterol?
High Cholesterol? 19.
19. Do you Do you use tobacco or use tobacco or have you have you used tobacco within the used tobacco within the last 5 ylast 5 years? If yes, ears? If yes, pleaseplease check one or more of the following:
check one or more of the following: Cigarettes
Cigarettes Cigar/pipe Cigar/pipe Chewing Chewing TobaccoTobacco 20.
20. Are you Are you physicallphysically y inactive (less than inactive (less than 3 days 3 days per week per week of physical of physical activitactivity).y).
21.
21. Please Please list list any any CardiovasculCardiovascular, ar, Pulmonary, Nervous Pulmonary, Nervous System, or System, or any any relatedrelated Medication that could impact how the body responds to exercise.
Medication that could impact how the body responds to exercise. Medication
Medication Name:_______Name:__________________ ___________ Purpose:_________Purpose:_____________________________________
22.
22. When When was was your your last last physical physical exam?exam?
23.
23. Do Do you you have have any any exercise exercise limitatiolimitations ns not not previously previously discussed discussed (i.e. (i.e. recent recent injuries,injuries, etc.)?
etc.)?
If yes, please explain: If yes, please explain:
24.
I understand that this form is not intended as a substitute for consultation with my I understand that this form is not intended as a substitute for consultation with my personal physician. I must consult my own personal physician for any evaluation of my personal physician. I must consult my own personal physician for any evaluation of my health status.
health status.
I certify that I have read and understand all questions on this health and exercise I certify that I have read and understand all questions on this health and exercise history questionnaire, and that all questions have been answered truthfully to the best of history questionnaire, and that all questions have been answered truthfully to the best of my knowledge. I agree to notify my personal trainer if there are any changes in the my knowledge. I agree to notify my personal trainer if there are any changes in the information that I have provided herein.
information that I have provided herein.
Signature:
Signature: ___________________________________________________ ___________________ Date: Date: ________________________________________
Personal Trainer/Fitness Staff Comments: Personal Trainer/Fitness Staff Comments: Date Received Form: __________________ Date Received Form: __________________
Date of Physician Consent Form given out: _____________ Date of Physician Consent Form given out: _____________ Date Physician Consent Form Returned: ________________ Date Physician Consent Form Returned: ________________ Additional Comments:
PERSONAL TRAINING WAIVER AND RELEASE FORM PERSONAL TRAINING WAIVER AND RELEASE FORM
I,_________________________________ , acknowledge that a Personal Training I,_________________________________ , acknowledge that a Personal Training Program is designed to improve my personal fitness by providing personalized and
Program is designed to improve my personal fitness by providing personalized and individualize
individualized attention by d attention by a qualified personal trainer. a qualified personal trainer. I understand that I understand that there may bethere may be health risks associated with activities using physical exertion in a personal training health risks associated with activities using physical exertion in a personal training program. The health risks include, but are not limited to, transient dizziness, fainting, program. The health risks include, but are not limited to, transient dizziness, fainting, nausea, muscle cramping, musculoskeletal injury, sprains and strains, heart attack, stroke nausea, muscle cramping, musculoskeletal injury, sprains and strains, heart attack, stroke or sudden death.
or sudden death. If I experience any If I experience any of these or any of these or any other symptoms while exercisinother symptoms while exercising, Ig, I will discontinue the activity, notify the personal trainer, and consult my physician. will discontinue the activity, notify the personal trainer, and consult my physician. ____
____ Prior to Prior to beginning a beginning a personal training personal training program, you may program, you may be required be required to complete to complete aa Personal Training Health Questionnaire.
Personal Training Health Questionnaire. The completion of The completion of the Personal the Personal Training HealthTraining Health Questionnaire will not result in any type of diagnosis of disease and is not intended as a Questionnaire will not result in any type of diagnosis of disease and is not intended as a substitute for consultation with your personal physician. The form is intended to identify substitute for consultation with your personal physician. The form is intended to identify any potential health risks that may require you to receive your physician's consent before any potential health risks that may require you to receive your physician's consent before participation. If after completing the Personal Training Health Questionnaire you have participation. If after completing the Personal Training Health Questionnaire you have been identified as someone who possesses certain risk factors, a signed Physician's been identified as someone who possesses certain risk factors, a signed Physician's
Clearance Form will be required before you participate in the Personal Training Program. Clearance Form will be required before you participate in the Personal Training Program. An optional Fitness Assessment will be offered to everyone participating in a program. An optional Fitness Assessment will be offered to everyone participating in a program. The personal trainers are not medically trained so no medical advice will be administered The personal trainers are not medically trained so no medical advice will be administered from a personal trainer before, during or after training sessions.
from a personal trainer before, during or after training sessions. _____
_____ I certify that I I certify that I am capable of performing physical exercise and acknowledge that Iam capable of performing physical exercise and acknowledge that I am voluntarily participating in Personal Training.
am voluntarily participating in Personal Training. I am I am participatiparticipating in ng in the Personalthe Personal Training Program with knowledge of
Training Program with knowledge of the dangers involved. the dangers involved. I understand that I I understand that I will bewill be fully responsible for complying with any restrictions prescribed for me by my personal fully responsible for complying with any restrictions prescribed for me by my personal physician and that I agree to consult my personal physician for further evaluation and physician and that I agree to consult my personal physician for further evaluation and such medical care as I require.
such medical care as I require. _____
_____ I acknowledge that my participation in the personal training program is atI acknowledge that my participation in the personal training program is at my sole
my sole risk.risk. You are advised to consult with your personal physician beforeYou are advised to consult with your personal physician before participation in the training sessions.
participation in the training sessions. If any client refuses to consult their physicianIf any client refuses to consult their physician before participating in any exercise program they must sign a Release of Liability Form before participating in any exercise program they must sign a Release of Liability Form and sign a Refusal of Medical Consultation Form (Members who have had a physical and sign a Refusal of Medical Consultation Form (Members who have had a physical exam within the year will also need to sign this form) If recommended by your physician, exam within the year will also need to sign this form) If recommended by your physician, you should consult with him/her on
you should consult with him/her on a regular basis. a regular basis. The personal trainer or other The personal trainer or other fitnessfitness staff will not be responsible for monitoring your compliance with your physician's
staff will not be responsible for monitoring your compliance with your physician's recommendations. Even consultation with your regular physician is in no way a recommendations. Even consultation with your regular physician is in no way a guarantee against the possibility of adverse occurrences during the training sessions. guarantee against the possibility of adverse occurrences during the training sessions. _____
_____ In consideration for my In consideration for my voluntary participation in the Personal Training voluntary participation in the Personal Training ProgramProgram I, my family, heirs, executors, representatives, administrators, and assigns do hereby I, my family, heirs, executors, representatives, administrators, and assigns do hereby waive, release, and forever discharge the company known as Fit2Be, and their respective waive, release, and forever discharge the company known as Fit2Be, and their respective managers/officers, directors, employees, and agents; and my personal trainer, from any managers/officers, directors, employees, and agents; and my personal trainer, from any and all responsibilities, liabilities and lawsuits, present or future, and causes of action for and all responsibilities, liabilities and lawsuits, present or future, and causes of action for
ordinary negligence, whether foreseeable or unforeseeable, arising out of or related in any ordinary negligence, whether foreseeable or unforeseeable, arising out of or related in any manner directly or indirectly, to my use of or access to the Fit2Be Services/Programs and manner directly or indirectly, to my use of or access to the Fit2Be Services/Programs and my participation in the
my participation in the personal training sessions. personal training sessions. This waiver includes, but This waiver includes, but is not limitedis not limited to such claims that may result from any injury, illness, or death, accidental or otherwise, to such claims that may result from any injury, illness, or death, accidental or otherwise, during or arising in any way from my participation in any exercise or recreation activity during or arising in any way from my participation in any exercise or recreation activity or fitness testing associated with the Personal Training Program. I hereby agree to
or fitness testing associated with the Personal Training Program. I hereby agree to expressly assume and accept sole responsibility for the risk of injury or death so long as expressly assume and accept sole responsibility for the risk of injury or death so long as they are not the result of gross negligence by the company known as Fit2Be and/or my they are not the result of gross negligence by the company known as Fit2Be and/or my personal trainer.
personal trainer.
I certify that I have read the above Personal Training Waiver and Release of I certify that I have read the above Personal Training Waiver and Release of Liability and have had any questions answered to my satisfaction.
Liability and have had any questions answered to my satisfaction.
Client:______
Client:_____________________________ _______________________ Date: Date: ______________________________________ Personal
