Physical Activity Readiness Questionnaire
Have you ever been a member of a Fitness Center or Coaching Facility before?
Please enter information...
If so, what did you like or dislike about that gym?
How long has it been since you’ve been on a consistent program?
Have you worked with a coach previously?
What are you looking for in your gym now?
Are we convenient for where you live? Yes Please check... NoPlease check... Where you work? Yes Please check... NoPlease check...
Do you have a significant other? Or will you be joining alone? Single Please check... Family Please check...
Is your significant other supportive of your fitness goals? YesPlease check... NoPlease check...
Do you have any children? Yes Please check... No Please check...
What is your motivation to workout?
When do you plan on exercising? How often?
Tell me more about your plan for when you get started. Warm up/Corrective Ex/Recovery
Do you have any medical conditions/injuries we should know about?
Tell me more about what your average daily nutrition looks like
How do you plan to monitor your progress? What is your measuring stick?
Lastly, how long have you been thinking about getting started?
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Personal Training Waiver of
Liability and Informed Consent
I Name , have enrolled in a program of strenuous physical activity Including but not limited to Yoga, weight training, stationary bicycling, and the use of various aerobicconditioning and strength building machinery offered by Stephen Frazier and Core Condition Fitness, LLC. I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this exercise program. In consideration for my participation in the Core Condition Fitness, LLC’s Exercise Program, I for myself, heirs and assigns, hereby release Core Condition Fitness, LLC, it's owners, associates, contractors, employees, vendors and or suppliers, Stephen Frazier and family members including any and all assets, from any claims, demands and causes of action arising from my participation in the exercise program.
This waiver of liability includes all training and or specialty classes such as fitness camps at 4000 W. Pioneer Pkw, suite 120, and any off-site training such as hikes, walks, runs, etc.
I fully understand that I may injure myself as a result of my participation in the Program at Core Condition Fitness, LLC and I , hereby release all associates of " Core Condition Fitness, LLC " as detailed above, from any liability now or in the future including but not limited to heart attacks, muscle strains, pulls, tears, broken bones, shin splints, knee/lower back/foot injuries and other illness, soreness, or injury however caused, occurring during or after my participation in the exercise program.
Stephen Frazier has recommended that I consult a Physician before I engaged in any physical exercise program. I acknowledge that I have done so, and that my Physician has cleared me for participation, or that, after rendering an individual decision, I have chosen not to consult a physician but will begin the exercise program on my own accord.
I have read this form and understand that there are inherent risks associated with my physical activity and recognize it is my responsibility to provide accurate and complete health/medical history information. Furthermore, it is my responsibility to monitor my individual physical performance during any activity.
In the event of a medical problem, I further recognize that any medical care that may be required is my personal financial responsibility.
Please sign Date
Client Signature Date of Signature
Witness Signature Date of Signature
