1. Personal Information:
Full Name*
First Name Last Name
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Phone Number*
Email*
example@example.com
Date of Birth*
Month Day Year
Gender*
Male Female
Put a face to the name.*
Age*
Height
Weight*
Pounds or Kilograms

4. Current Condition
4.1 Activity Levels:
Current Fitness Level:*
0
1
2
3
4
5
6
7
8
0 is Couch Potato, 8 is Gladiator
Sports and Hobbies:
Exertive Physical Activity per day
Minutes
Where do you like to work out ?
What type of workout equipment do you have at home ?
Weight Loss Program Before
Worked with a Trainer before ?
Goals & Outcome

Training Terms and Conditions
1.) CANCELLATIONS
Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.
2.) LATE ARRIVALS
Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.
3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT
All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
Name
First Name Last Name
I AGREE TO THE ABOVE TERMS & CONDITIONS!*
Yes No
Signature
Clear

Liability Waiver
I First Name* Last Name* Will not hold Judith Pelser or any other persons and business liable for any injury (physical or emotional) contracted prior, during or after training with Judith.
I understand that it is up to me to take the necessary safety and health precautions prior, during and after all training sessions.
Signature*
Clear

Covid Waiver
I First Name* Last Name* Will not hold Judith Pelser or any other persons and business liable for any illness (physical or emotional) contracted prior, during or after training with her.
I understand that it is up to me to take the necessary safety and health precautions prior and during all training sessions. I feel unsafe, it is my responsibility decline training.
Signature*
Clear
Should be Empty: