Part A: Personal Details & Exercise Habits

MaleFemale

NoYes


Part B: Lifestyle & Special Conditions


Heart diseaseAsthmaHeart ConditionDiabetesBack PainSpinal InjuriesHerniaEpilepsyArthritisPregnancyAllergies to GrassBladder WeaknessThyroid DisorderHeart PalpitationsJoint PainsHigh or Low Blood PressureTightness in ChestRheumatic FeverLiver/Kidney ConditionRegular HeadachesInfectionsMuscular pains/crampsChronic CoughHigh CholesterolOther

NoYes


NoYes

NoYes

NoYes

NOTE: You may need doctor’s clearance if you have ticked yes to any of the above questions.


Part C: Goals and Achievements


Weight LossGeneral WellbeingMuscle GainGoal for a special occasionGeneral muscleToningTraining for an eventRehabilitationManagement of a Special ConditionTime for yourselfIncrease strengthIncrease EnduranceOther

Client Consent Form

IMPORTANT INFORMATION: Participant must complete truthfully and understand fully the importance and relevance of this document. The document is not valid until the participant has agreed to its conditions and returned to the trainer. This document is not valid for people under the age of 18 years.

General Statement of Program Objectives and Procedures

I understand that this physical fitness program includes exercises to build the cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance and strength, and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone). Exercise may include aerobic activities (treadmill, walking, running, bicycle riding, rowing machine exercises, group aerobic activity, swimming and other aerobic activities), callisthenic exercises, and weight lifting to improve muscular strength and endurance and flexibility exercises to improve joint range of motion.

Potential Risks

I understand that the trainer shall not be liable for any damages arising from personal injuries sustained by the client while and during the training program. The client using the exercising equipment during the personal training program does so at his/her own risk. The client assumes full responsibility for any injuries or damages which may occur during the training. I hereby fully and forever release and discharge the trainer, its assigns and agents from all claims, demands, damages, rights of action, present and future therein.

I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, comfort, or physical condition if I engage or participate (other than those items fully discussed on health a history form).

I state that I have had a recent physical consultation and have my personal physician's permission to engage in aerobic and/or anaerobic conditioning.

Potential Benefits:

I understand that a program of regular exercise for the heart, lungs, muscles and joints, has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function, and decrease in heart disease.

I have read the foregoing information and understand it. Any questions I have asked have been answered to my satisfaction.


Terms and Conditions

Our commitment to you:

a. Confidentiality. All information you give me will be kept in confidence. Your personal details and medical information will not be made available to third parties unless permission to do so is granted by you.
b. Recommendations. Using my judgement and experience, I will suggest certain exercises and other lifestyle advice that I believe will help you achieve your personal goals, but if at any time you have specific requests please tell me so I can accommodate them.
c. Referral. I intend to work with you within the scope of my knowledge and competencies as Registered Exercise Professional. Therefore when I believe it is in your best interests to see another health professional, I will refer you appropriately.
d. If we (the trainer/instructor/s) cancels or runs late. In the event sessions cannot be performed as scheduled, we will do our best to reschedule the session at a suitable time for both parties.
The Trainer/Instructors will deliver their sessions and advice to the best of their ability, will be registered with Fitness Australia, and will respect all applicable Australian laws and Fitness Industry Code of Practice at all times.

Your responsibilities to us:

a. Disclosure of information. Please disclose all health information as requested at our initial consultation and keep me updated and informed of any changes to your health status. This includes all medical conditions; physical and mental, injuries, allergies, and medication you are taking. If necessary, you may need to seek clearance from your doctor before participation in the exercise programme I recommend.
b. If you (the client) cancel or run late. In the event the client cancels, does not attend, is late then the client may forfeit their session. We will do our best to reschedule or offer alternative sessions. If the cancellation is within a 24 hour period the session may not be able to be rescheduled.
c. Accepting payment terms. The client understands that they are paying the trainer for their services as outlined in this agreement. In the event that the client doesn’t use the services, the client will still be responsible to make payment for the full initial term as agreed above. The client agrees to make all payments by the due date. No refund are available and deferrals and transfers of fees is left to the discretion of the operator.

I agree