Personal Training/medical Forms (Page 2 of 2) in pdf

Diabetes? ___ Yes ___ No

Obesity? ___ Yes ___ No

Dizziness/loss of consciousness? __ Yes __ No

Arthritis? ___ Yes ___ No

Seizures or Convulsions? ___ Yes ___ No

Bone, joint, or muscle injury? __ Yes __ No

Severe Headaches? ___ Yes ___ No

Low Back Pain? ___ Yes ___ No

Surgery (s)? - What, when, why, how many? ________________________________________________

_____________________________________________________________________________________

What does your physician recommend? ___________________________________________________

_____________________________________________________________________________________

*CONSULT YOUR PHYSICIAN BEFORE BEGINNING IN ANY EXERCISE PROGRAM

Waiver and Release

I (the client) _______________________ agree that if I engage in any physical exercise, class, or activity,

I do so at my own risk. I agree that I am voluntarily participating in activities and assume all risk of injury

or illness. I agree to release and discharge (my trainer) ______________________ from any and all

claims or causes of action (known or unknown) arising out of my negligence. I acknowledge that I have

carefully read this waiver and Release and fully understand that it is a release of liability. I am waiving

any right that I may have to bring a legal action to assert a claim against my trainer for his/her

negligence.

Client’s Signature: ____________________________________________

Date: _____________

Rules and Regulations for Personal Training Sessions

The expiration policy requires completion of an average of one session per week from the date of

purchase.

You may reschedule a workout session one day (24 hours) before the scheduled session without a

penalty. Within that time you must pay for that session unless arrangements have been made with the

trainer.

A member arriving late will only receive the remaining scheduled time for their session. A “no show”

will be charged for the session.

No refunds, unless the trainer cannot continue the session.

Client’s Signature: ____________________________________________

Date: ____________

Personal Training/medical Forms Page 2