New Client Health Questionnaire Agreement

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NO EXCUSE FITNESS
CONSULTATION AGREEMENT & HEALTH QUESTIONNAIRE

NAME:
ADDRESS:
 		CITY:
ZIP:
HOME PHONE:
 		WORK PHONE:
 		CELL:
EMAIL:
 		AGE:
GENDER:
Emergency Contact:  
Emergency Number(s):  
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Email Used: 


ALL exercise and use of all facilities, as well as in home or office training shall be undertaken by guest at guest’s sole risk. NO EXCUSE FITNESS and or independent contractor shall not be liable for any claims, demands, injuries, soreness, or causes of action whatsoever, to person arising out of or connected with the use of any services, facilities, equipment, and/or coaching/exercise suggestions of NO EXCUSE FITNESS and/or independent contractor.I have read agreement and rules and regulations of NO EXCUSE FITNESS and/or independent contractor, which are incorporated herein by reference, and I agree to be bound by their terms and conditions.

MEDICAL HISTORY

 Cardiological problems  Seizures/neurological illness
 Family history of coronary heart disease  Vitamin/Supplements
 Recent surgery  High cholesterol
 Bone/injury/muscle disorder  Asthma/Respiratory illness
 Stroke  Intestinal disease
 Cancer  Hypertension
 Allergies  Pregnant
 Physician’s advice not to exercise  Smoking
 Chest pain  Hernia/condition that prevents you from lifting weights
 Diabetes
 Medications (specify below)


IF YOU CHECKED ANY OF THE ABOVE QUESTIONS, PLEASE GIVE A BRIEF EXPLANATION:


SIGNATURE:

Clear
(draw your signature)

DATE: 10/04/2017

NO EXCUSE FITNESS CLIENT AGREEMENT 

This Agreement is made and entered into effective at the start of the sessions. The initial contract Waiver of Liability effective indefinitely, by and between NO EXCUSE FITNESS in home or studio. NO EXCUSE FITNESS, hereinafter referred to as NEF, Client, who agrees to the following terms and conditions.

ASSESSMENT OF RISK:
I, CLIENT understands and am aware that strength, flexibility and aerobic exercise, including the use of equipment is potentially hazardous activity. I also understand that fitness activities involve a risk of injury, soreness and/or other illness and death. I am voluntarily participating in these activities, physical contact, using equipment and machinery with knowledge of the dangers involved.

I hereby agree to expressly and accept all risks of injury, soreness, other illness or death.

PHYSICAL AND DIETARY ASSESSMENT:
I, CLIENT acknowledge that NEF has made no claims or representations as to medical results and that NEF has encouraged CLIENT to consult his/her physician before beginning an exercise program or alternating his/her dietary regimen (including supplements). All and any exercise and/or diet statements, articles or papers given to CLIENT are intended only as a general guide.

There is much controversy regarding the action and uses of many vitamins and supplements. Any information provided is not intended to be interpreted as indisputable scientific data.

WAIVER OF LIABILITY:
I, CIENT hereby waive, release and now or in the future discharge and its independent contractors, representatives or executors and or all others from any and all claims, demands, responsibilities or liability from injuries/damages resulting from my participation in any activities, physical contract or use of equipment/machinery, including those negligent act or omission or connected with my participation in NEF and its representatives or executors and all others from any claims, demands or actions arising out of exercise suggested and completed at home, fitness clubs or gyms with or without proper supervision.

FITNESS CONDITION ACKNOWLEDGMENT:
I, CLIENT, hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment, machinery, stretches or message. I have been informed of the need for a physician’s approval to participate in the NEF exercise program including future participation. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to the physical activities, training, equipment, stretching and massage. I have had either a physical examination and/or have been given my physician’s permission to participate or I have decided to participate in activity, physical contact and use of equipment and machinery without the approval of my physician.

GENERAL POLICIES:

  • Package payments are due, in full, the session before the last scheduled session or before the date agreed by CLIENT and NEF. Services will not be rendered if sessions are not paid in full.
  • A seventy-two hour (72) notice is required if the CLIENT:

- does not wish to renew a 30 day training package.
- takes a vacation-leave or extended sick-leave (in order to credit the sessions left, upon return).\

  • ​Return check fee is $10.00 plus full amount owed.
  • CLIENT must give NEF 12 hour notice on cancellation or rescheduling of session(s) or CLIENT is charged for that session.
  • CLIENT can place a hold on their account, CLIENT must inform NEF within 24 hours of next scheduled session. CLIENT shall have (360) days to finish any remaining sessions in a package. All Holds Must be in a time stamped format Either Text, email or Letter.
  • If trainer should miss a scheduled session then the CLIENT is credited the missed session.
  • SESSIONS CAN BE PUT ON HOLD & BE TRANSFERABLE, up to 360 DAYS
  • THERE ARE NO REFUNDS "Only on Billing Errors"
  • RATES ARE ALWAYS SUBJECT TO CHANGE
  • Future Scheduled Times are not Always guaranteed it's at the discretion of NEF

​SIGNATURE:

Clear
(draw your signature)

DATE: 10/04/2017

Name of Adult Participant:

First Name: Last Name: Age:
Address: City: State:
Zip: Email: Phone:
Date and Time Signed: 21/11/2024 07:41
System Time Stamp: 21/11/2024 07:41