Prior to your first personal training session please fill out the waiver, exercise readiness and lifestyle questionnaire.

 

Name *
Name
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
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?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Signature
Signature
I have read, understood and completed this questionnaire. Please enter the following fields for name and date to sign this waiver.
Date
Date
Name *
Name
Date *
Date
Any injuries past or present that would affect or limit your performance?
On a scale of 1 worst ever to 10 best ever how would you rate your current level of fitness?
How many times per week do you typically take part in physical activities?
If you are presently inactive, when was the last time you exercised regularly?
If presently active, what sorts of activities are you involved in? Strength training, cardio exercise and/or flexibility training (please list). How many times a week?
On average how many hours do you sleep per night?
Do you drink an adequate amount of water? (64oz. or more)
Do you drink coffee, tea, soda or diet soda? How much per day?
Please describe any medical/health conditions or diagnosis that may affect your ability to exercise.
Do you feel you have any obstacles (actions , behaviors, or activities)that may impede your progress towards accomplishing your goals? For example: inconsistency, not prioritizing your health, not changing your workout program.
Give a brief description of your fitness/wellness goals.
Member’s Acknowledgment and Assumption of Risk and Full Release from Liability Member acknowledges that the personal training/fitness assessment hereunder include participation in strenuous physical activities, including but not limited to, aerobic movement, weight training, and various aerobic conditioning offered by Kathy Coté of Katalyst Fitness. Member agrees to assume all risk and responsibility involved with participation in the physical activities. Member affirms that he/she is in good physical condition and does not suffer from any disability that would prevent or limit participation in physical activities. Member acknowledges that participation will be physically and mentally challenging, and member agrees that it is the responsibility of the member to seek competent medical or other professional advice regarding any concerns involved with the ability of member to take part in physical activities. Member agrees to assume all risk and responsibility for not exceeding his/her physical limits.
Name *
Name
I have read and understood this waiver. Please enter the following fields for name and date to sign this waiver
Date
Date