Client Record Form

Must be completed prior to first training session or as requested

CLIENT RECORD FORM

First name

Last name

Address

Mobile

EXERCISE HISTORY

If YES, please note here

Any additional information you deem relevant for your trainer, please note here - thank you

MEDICAL HISTORY

If you have responded YES to any of the above Medical History questions please provide more information here - thank you

PERMISSIONS

I believe that to the best of my knowledge, all if the information I have supplied in this form is correct.

PERFIT WAIVER

PEFIT strongly recommends that you consult with your Physician, or appropriate Allied Health Professional (AHP) before beginning any PERFIT Personal Training exercise session(s).

You should be in good physical condition and be able to participate in the exercise session(s).

PERFIT is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific exercise on a medical condition or physical injury.

If you have answered ‘YES’ to any of the first 7 questions in the Medical History section, but do not wish to consult with your Physician/AHP prior to commencing your PERFIT Personal Training exercise session(s), you agree to do so at your own risk, are voluntarily participating in the activities, assume all risk to yourself, and agree to release and discharge PERFIT from any and all claims or causes of action, known or unknown, arising out of alleged negligence.

You should understand that when participating in any PERFIT Personal Training exercise session(s), there is the possibility of physical injury or aggravation to an existing medical condition. If you engage in the exercise session(s), you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk to yourself, and agree to release and discharge PERFIT from any and all claims or causes of action, known or unknown, arising out of alleged negligence.

It is your responsibility to notify PERFIT of any significant changes to your physical condition (ie: injury / medical condition) prior to commencing an exercise session.

I have read, understood and accept the conditions of the PERFIT Waiver.

Your Form & Waiver Signature

Date

Thanks for submitting!