• Personal Training with Jacques

    Personal Training with Jacques

    Welcome & Thank you for choosing Training with Jacques for your fitness & nutritional coaching.

  • Client Registration & Health Screening Questionnaire

    Your health, safety and well-being are our highest priority. Before beginning any exercise program, please complete this questionnaire honestly and accurately. The information you provide will remain confidential and will only be used to help us provide safe and appropriate exercise guidance.If your health status changes at any stage during your training program, you agree to inform your trainer before participating in further sessions.

  • INFORMED CONSENT & ASSUMPTION OF RISK

    I understand that Jacques Personal Training provides personal training, fitness instruction, exercise guidance, physical conditioning and general wellness support.I understand that the purpose of this form is to confirm that I have been informed of the nature of the services, the possible risks involved in physical exercise, and my responsibility to disclose relevant health information before participating.

  • CONSENT TO PARTICIPATE

    I confirm that: I have read and understood this informed consent form; I have had the opportunity to ask questions; I voluntarily agree to participate in personal training and related physical activity; I understand the nature of the services; I understand the risks involved; I accept the ordinary risks associated with exercise; I understand that I may stop participating at any time. By proceeding & signing this form, I confirm that I voluntarily choose to participate in personal training sessions and related physical activity with Jacques Personal Training.

  • CONSENT TO PARTICIPATE

    I confirm that: I have read and understood this informed consent form; I have had the opportunity to ask questions; I voluntarily agree to participate in personal training and related physical activity; I understand the nature of the services; I understand the risks involved; I accept the ordinary risks associated with exercise; I understand that I may stop participating at any time. By proceeding & signing this form, I confirm that I voluntarily choose to participate in personal training sessions and related physical activity with Jacques Personal Training.

  • Personal Information

  • Client Details

    Client Registration - Step 1 - Basic Information
  • Gender*
  • Format: (000) 000-0000.
  • Can you be contacted by whatsapp on the above number?*

  • Nature of Personal Training Services

    I understand that personal training sessions may include, but are not limited to:

    • Cardiovascular exercise
    • Resistance training
      Strength training
    • Mobility and flexibility work
    • Bodyweight exercises
    • Balance and coordination exercises
    • Functional movement training
    • Fitness assessments
    • Exercise demonstrations
    • General lifestyle, wellness and fitness guidance

    By selecting the box and/or completing this registration, I confirm that I voluntarily choose to participate in personal training sessions and related physical activity with Training with Jacques, and that the exact exercises, intensity, duration and training methods may vary depending on my goals, fitness level, health status, progress and the professional judgement of the trainer.

    • Basic Information Section 

    • Emergency Contact

      Client Registration - Step 2 - Emergency Details
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.

    • Emergency Medical Assistance

      In the event of a medical emergency, injury, fainting, collapse or other urgent health concern, I consent to Jacques Personal Training taking reasonable steps to assist me. This may include: Contacting my emergency contact.;calling emergency medical services.; providing basic assistance within the trainer’s knowledge and ability; sharing relevant health information with emergency responders where reasonably necessary. I understand that I remain responsible for any medical, ambulance, hospital or related costs arising from such emergency assistance. By proceeding beyond this section and completing this registration process, I confirm that I understand, accept & agree to these terms and conditions. listed above.

  • Health Information

  • Do you take any medications?*
  • Do you have any allergies?*
  • Do you smoke, vape or similar?*
  • Do you consume alcohol?*

  • MEDICAL HISTORY

  • Have you experienced any injuries within the past five years?
  • Are you currently, or suspect yourself likely to be pregant?
  • Have you, or anyone of your immediate family been diagnosed of heart disease before the age of 60?*
  • Please indicate if you have ever been diagnosed with any of the following?*

  • Disclosure of Health Information

    I confirm that I have completed the Client Registration & Health Screening Questionnaire honestly, accurately and to the best of my knowledge.

    I understand that Jacques Personal Training relies on the information I provide in order to assess whether I may participate in exercise safely.

    I agree to disclose all relevant information relating to my health, fitness, injuries, medication, medical history and physical limitations.

    This includes, but is not limited to:

    • Heart conditions
    • High or low blood pressure
    • Chest pain
    • Breathing difficulties
    • Asthma
    • Diabetes
    • Epilepsy
    • Fainting, dizziness or blackouts
    • Joint, bone or muscle problems
    • Back, neck, knee, shoulder or hip injuries
    • Surgery or recent medical procedures
    • Pregnancy or recent childbirth
    • Medication use
    • Allergies
    • Any condition that may affect my ability to exercise safely

  • Physical Activity Readiness Questionnaire (PAR-Q)

    Please answer YES or NO to each question.
  • Has your doctor ever said that you have a heart condition or that you should only do physical activity recommended by a healthcare professional?*
  • Do you experience chest pain during physical activity?*
  • Have you experienced chest pain while resting within the past month?*
  • Do you lose your balance because of dizziness or have you ever lost consciousness?*
  • Do you have any bone, joint or muscle problem that could become worse through exercise?*
  • Has your doctor prescribed medication for your heart or blood pressure?*
  • Do you know of any medical condition not already mentioned that may affect your ability to exercise safely?*
  • Are you recovering from surgery or awaiting a medical procedure?*
  • Has a healthcare professional ever advised you not to participate in vigorous exercise?*
  • Is there any other reason why you believe you should not participate in physical activity?*

  • No Medical Advice

    I understand and accept that Training with Jacques is not a medical practice and does not provide medical diagnosis, medical treatment, physiotherapy, psychological treatment, dietetic treatment or any other regulated healthcare service.I understand that any fitness, wellness, lifestyle or exercise information provided is general in nature and does not replace advice from a doctor, physiotherapist, dietitian, psychologist or other suitably qualified healthcare professional.I agree to consult a healthcare professional before starting or continuing exercise if I have any medical condition, injury, concern, symptom, pregnancy-related concern, or if I am uncertain whether exercise is safe for me.

  • Client Declaration

    I declare that the information provided in this questionnaire is true, complete and accurate to the best of my knowledge.

    I understand that withholding relevant medical information may increase my risk of injury.

    I agree to inform Jacques Personal Training immediately if my health condition changes.

    I understand that this questionnaire does not replace medical advice and that I should consult my healthcare provider if I have any concerns regarding my participation in exercise.

    I understand that Jacques Personal Training may refuse or postpone training until medical clearance has been obtained where this is considered necessary for my safety.

    By proceeding this section and completing this form, i confirm that I understand, accept & agree to these terms and conditions.

  • If you answered YES to any PAR-Q health screening question, Jacques Personal Training may require written medical clearance before commencing or continuing exercise.Have you obtained medical clearance?*
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  • Current Lifestyle

  • Whats the activity level of your daily life?
  • Your current diet could be best characterized as:*

  • Goals

  • Please rate your readiness for change.
  • What following goals does best fit in with your goals?
  • Rows
  • Please rate your motivational level to do what it takes for reach your goal.
  • Are you currently excersising regulary (at least 3x per week)?
  • Have you trained with a personal trainer before?
  • At what times during the day would you prefer to train?
  • PT 60 Package Options
  • PT 30 Package Options

  • 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.

  • I AGREE TO THE ABOVE TERMS & CONDITIONS*
  • Date*
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