Personal Training Sign Up Form Name (First,Last) Email Date of Birth Phone Address Do you have any specific medical conditions such as heart disease, asthma, diabetes, epilepsy, joint or muscular injuries? Please list your medical concerns and any medication or supplements including frequency and purpose. Regularly (3-4x/week) Semi regularly (1-2x/week) Sporadically (1-2x/month) Please explain your current exercise regime or activities performed in the past: List cardiovascular training exercises you enjoy: List strength training exercises you enjoy: What are your personal barriers for not exercising or sticking to an exercise program? How much time can you budget for your exercise program? (Minutes/day, Days/week) Why have you decided to participate in a MPF program? Need motivation and accountability Improve physical fitness & strength Weight loss/management Post rehabilitation training Boredom with current routine Other Describe what you would like to accomplish in your sessions: Specify your goals for the following time periods: 1 month, 6 months, 1 year: NutritionNumber of each meal (per week) you eat away from home on weekdays? (Breakfast, Lunch, Dinner) Number of meals (per week) you eat away from home on weekends? (Breakfast, Lunch, Dinner) Do you skip meals? Yes/No. If Yes, which meals and reason for skipping? List restaurants where you often eat: Do you currently take vitamins, minerals, dietary supplements or meal replacement products? Please list items and how often you take them: Personal Training Participation Agreement FormTraining Sessions:Personal training sessions will last for 30/60 minutes unless otherwise noted. Please make every effort to be on time so that you can get the most out of your training. If you are late for a session, that session will still end at the regular time. By typing your name here, you agree to this term. Cancellation Policy:If you are not able to attend a session, please inform us 24 hours in advance. You may leave us a message on MPF’s voicemail at (701) 353-5000 or email Brad@MPFitness.net. Failure to notify us within 24 hours of a scheduled session will result in you being charged the full session fee. We will call you promptly to schedule your next session. By typing your name here, you agree to this term. Media:You understand that Maximum Performance & Fitness, LLC may take pictures and video for promotional purposes only and you may choose not to be involved. Inform Brad by emailing Brad@MPFitness.net in writing so we can be sure to keep you out of picture and video. By typing your name here, you agree to this term. Nutrition Coaching:You understand that Maximum Performance & Fitness, LLC may or may not have a Licensed Nutritionist or a Registered Dietician on staff. Understanding this, you agree to waive any claims against Brad Nordstrom, his heirs or assigns and Maximum Performance & Fitness, LLC regarding any nutritional recommendations, nutritional programs, dietary supplements recommended or dietary supplements purchased from Maximum Performance & Fitness, LLC. By typing your name here, you agree to this term. Medical insurance:You understand the medical risks involved with physical activity and the need for medical insurance. By typing your name here, you acknowledge that you have a medical insurance policy in force, and that such insurance will be your primary source of payment should medical treatment be necessary. Waiver and Release:I have read the preceding and agree with each term above and acknowledge such agreement by my signature below. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS, Brad Nordstrom, his heirs or assigns, and Maximum Performance & Fitness, LLC and its assigns from all liability, claims, demands, losses, or damages I may have as a result of my participation in activities associated with personal training, fitness instruction, or nutrition coaching. I ALSO HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS Brad Nordstrom, his heirs or assign, and Maximum Performance & Fitness, LLC, and its assigns for any act or omission relating to nutritional advice or nutritional guidance provided to me. By typing my name, below, I am agreeing to all terms in this Agreement. I recognize that this electronic signature has the same force and effect as a manual signature and my execution of this electronic signature constitutes my valid and binding signature for all purposes. Send