RT intake form

 

remote training Intake

 

Completion of the following forms is required prior to beginning your training.

If you have any questions or concerns during the process, please email contact@themvmt.co


 
 
 

Assumptions of Risk, Waiver and Release of Liability and indemnity agreement


DECLARATIONS

This Agreement is entered into between personal trainer Lauren Schramm (“Trainer”) and the undersigned (“Client”). The provision of personal training services by Trainer to Client, and Client’s use of any premises, facilities or equipment are contingent upon this Agreement.

ASSUMPTION OF RISK

You agree that if you engage in any physical exercise or activity, including personal training, or enter the premises or use any facility or equipment accompanied by Trainer, for any purpose, you do so at your own risk and assume the risk of any and all injury and/or damage you may suffer, whether while engaging in physical exercise or not. This includes injury or damage sustained while and/or resulting from using any premises or facility while accompanied by Trainer, or using any equipment, whether provided to you by Trainer or otherwise, including injuries or damages arising out of the negligence of Trainer, whether active or passive, or any of Trainer’s affiliates, employees, agents, representatives, successors, and assigns. Your assumption of risk includes, but is not limited to, your use of any exercise equipment (mechanical or otherwise), sports fields, courts, or other areas, locker rooms, sidewalks, parking lots, stairs, lobby or other general areas of any facilities, or any equipment. You assume the risk of your participation in any activity, class, program, instruction, or event, including but not limited to weightlifting, walking, jogging, running, aerobic activities, aquatic activities, yoga, basketball, tennis, racquetball, or any other sporting or recreational endeavor. You agree that you are voluntarily participating in the aforementioned activities and assume all risk of injury, illness, damage, or loss to you or your property that might result, including, without limitation, any loss or theft of any personal property, whether arising out of the negligence of Trainer or otherwise.

RELEASE

You agree on behalf of yourself (and all your personal representatives, heirs, executors, administrators, agents, and assigns) to release and discharge Trainer (and Trainer’s affiliates, related entities, employees, agents, representatives, successors, and assigns) from any and all claims or causes of action (known or unknown) arising out of the negligence of Trainer, whether active or passive, or any of Trainer’s affiliates, employees, agents, representatives, successors, and assigns. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) your use of any exercise equipment or facilities which may malfunction or break, (b) improper maintenance of any exercise equipment, premises or facilities, (c) negligent instruction or supervision, including personal training, (d) negligent hiring or retention of employees, and/or (e) slipping or tripping and falling while on any portion of a premises or while traveling to or from personal training, including injuries resulting from Trainer’s or anyone else’s negligent inspection or maintenance of the facility or premises.

INDEMNIFICATION

By execution of this agreement, you hereby agree to indemnify and hold harmless Trainer from any loss, liability, damage, or cost Trainer may incur due to the provision of personal training by Trainer to you. ACKNOWLEDGMENTS: You expressly agree that the foregoing release, waiver, assumption of risk and indemnity agreement is intended to be as broad and inclusive as permitted by the law in the State of New York and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. You acknowledge that Trainer offers a service to his/her clients encompassing the entire recreational and/or fitness spectrum. Trainer is not in the business of selling weightlifting equipment, exercise equipment, or other such products to the public, and the use of such items is incidental to the service provided by Trainer. You acknowledge and agree that Trainer does not place such items into the stream of commerce. This release is not intended as an attempted release of claims of gross negligence or intentional acts.

 

You acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability, express assumption of risk and indemnity agreement. You are aware and agree that by executing this waiver and release, you are giving up your right to bring a legal action or assert a claim against trainer for trainer’s negligence, or for any defective product used while receiving personal training from trainer. You have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

Assumptions of Risk, Waiver and Release of Liability, and Indemnity Agreement *
Print Name *
Print Name
Today's Date *
Today's Date
 

personal training terms and conditions


24 HOUR CANCELLATION POLICY

A client that has made an appointment for a session may cancel or change the time of the session provided that a minimum of 24-hours’ notice is given. You can make these changes via "My Schedule" in the SetMore Scheduling App or by contacting your trainer directly. Clients will forfeit the full cost of the session on any late cancellations, attempts to reschedule or no-show appointments.

DISCOUNTS

Lauren Schramm Fitness may offer discounts on sessions to clients who purchase a package of sessions. These discounts only apply to the number of sessions purchased as a group. Any further or additional sessions will be charged at the regular rate then in effect for individual sessions.

MINIMUM COMMITMENT

All clients are required to complete a minimum of 3 months of Remote Training under any program option. After the completion of the initial 3 month period, you may cancel at any time. If cancellation occurs after the billing of a monthly payment term, refunds for that month and/or pro-rated refunds will NOT be made available to the client.

SUBSCRIPTION PAYMENT TERMS

Remote training programs will be billed automatically on a monthly schedule. It is required that you keep an updated credit card on file with Stripe so that all payments can be processed successfully in a timely manner.

EXPIRATION POLICY

All sales are final, but transferable. Sessions expire six months from the date of purchase.

Terms and Conditions *
Print Name *
Print Name
Today's Date *
Today's Date
 

PAR-Q + INtake

Basic Information
Name *
Name
Birthday *
Birthday
Home Gym or Private Training Gym Address *
Home Gym or Private Training Gym Address
Please enter the address of the facility we will be using to complete your in-person training sessions.
Program Choice *
Goals
What Are You Looking to Achieve? *
Choose all that apply. If one or more of the selections is marked with an asterisk, please explain below.
Please explain your goals + objectives in more detail. Add anything else that you would like me to know.
Which statement fits best?
Does seeing progress in numbers like your weight, body fat percentage, etc. help you stay motivated?
How Would You Like to Track Your Progress? *
Check all that apply.
Availability
Try to make a realistic estimation.
Preferred Rest Days *
Let me know if there are any days of the week you will not be able to complete a workout or would prefer not to train.
How Much Time Do You Have to Dedicate to Each Training Session? *
Best Day of the Week to Schedule Your In-Person Training Sessions *
Check all that apply.
Best Time of Day to Schedule Your In-Person Training Sessions *
Check all that apply.
Digital Communication + Accountability
Programs will be delivered via email by EOD.
Do You Feel Comfortable Filming Yourself Completing Certain Exercises During Your Workout? *
This would be required on occasion to ensure proper form.
Current Fitness Routine
Which statement fits best?
Which statement fits best?
My Cardio Vascular Workouts Consist of: *
Check all that apply.
Include duration and frequency for each type of exercise.
My Strength Training Workouts Consist of: *
Check all that apply.
Include duration, frequency, and set/rep scheme for each type of exercise.
I Plan to Continue to Participate In: *
Check all that apply and I will work these into your programming.
Feel free to provide a range if you're unsure.
If you have a regular class time or schedule you would like to incorporate or maintain as part of your routine, please provide as much detail as possible.
Equipment Access
Which Pieces of Equipment Will You Have Regular Access To? *
Check all that apply.
Do You Travel with Any of the Following Items? *
Check all that apply.
Wellness Habits
Sleep Habits *
Check all that apply.
Stress levels *
Stress levels
I believe that a certain level of stress is necessary for a productive life.
My stress levels are well managed and rarely elevated.
I have tactics to lower my stress levels if they begin to elevate.
Most of my stress is unavoidable and due to my job.
I use coping mechanisms to deal with, lower and escape from my stress.
Dietary Habits
On average, including snacks.
Basic Nutrition Scale *
Basic Nutrition Scale
There's room for improvement in regards to my diet.
I believe that I eat a healthy, well-rounded diet.
I place restrictions on my food choices and portions.
I eat well during the week and things go south on the weekends and when I've been drinking.
I only eat when I'm hungry.
I view food mainly as a source of pleasure and enjoyment.
I feel out of control of my habits in regards to nutrition.
I often feel sluggish, stuffed, and uncomfortable because of the foods I choose to eat.
I eat a healthy diet but find myself struggling with sweets and dessert.
I have a good understanding of how much food I should be eating per meal and what a serving size looks like.
I have a good understanding of the differences between the three types of macronutrients and what each does for my body.
I use food and alcohol consumption as a reward for myself.
I find myself regretting food choices after I make them.
I often experience cravings for certain types of food that feel so strong I have trouble ignoring them.
Would You Like Some Dietary Guidance? *
Do You Follow Any Special Diets? *
Check all that apply.
Policy Agreement
I Would Prefer to Complete Payment Via
This Program Requires Me to Complete a Minimum of 3 Months of Remote Training Before I Have the Option of Discontinuing. *
All In-Person Training Sessions Are Subject to Availability and Require a Minimum of 24-Hours Notice to Reschedule. *
I Am Required to Give a Minimum of 1 Weeks Notice Before the Subsequent Month of Programming Is Set to Begin If I Would Like to Discontinue My Remote Training Program. *
The last possible day to cancel your program for the following month is on the 20th of the month prior.
If I Have Specific Questions or Problems Regarding the Policies and Need Special Attention or an Exceptions to Be Made, I Will Feel Comfortable Reaching out to Discuss My Options. *
Additional Information
 

Medical History


Name *
Name
If unknown, leave blank.
To calculate: While seated in a rested state, place your pointer and middle finger on thumb-side of the inside of your opposite wrist. Set a timer for 10 seconds and count the number of beats you feel and multiply by 6.
General Health
Which Statement Fits Best? *
How would you describe your current general health and injury status?
Please outline any specific injuries/illnesses from the past and present.
Have You Had a Heart Condition? * *
Do You Experience Discomfort in Your Chest (During Exercise or Not)? *
Do You Experience Unreasonable Breathlessness? *
Do You Experience Dizziness, Fainting, or Blackouts? *
Do You Experience Any of the Following Conditions?
Do You Take Any of the Following Prescription Medications? *
Some medications come with side effects that can potentially alter your natural abilities to lose/gain weight and alter your athletic performance.
Are You Pregnant or Looking to Become Pregnant? *
Medical + Family History
Have Any Immediate Family Members Experienced the Following? *
Check all that apply.
Lifestyle
Do You Currently Smoke Cigarettes? *
Were You a Cigarette Smoker in the Past? *
Supplements
Check All Supplements That You Regularly Take.
Weight Fluxuation
Have You Ever Experienced Dramatic Weight Loss or Weight Gain? *
Consider both weight fluxations above 15 lbs and considerable changes in weight over less than a 3 month period of time.
Additional Information
 

all done.

You will receive an email detailing next steps