Client Details
First Name
Last Name
Date Of Birth
Street Address
Suburb
Postcode
Contact Number
Email
Occupation
Have you had a Personal Trainer before?
Where did you hear about Epic Win PT?
Emergency Contact
Name
Contact Number
Relationship
What brings you to Epic Win PT?
What do you consider to be your number one priority?
Name two areas of your life which you are not happy with right now and would like to improve
Medical Background
DO YOU HAVE OR HAVE YOU EVER HAD ANY OF THE FOLLOWING
If you have ticked any of the above, a medical clearance from your doctor or specialist may be required prior to commencing your exercise program in the interest of your personal safety.
Is there a family history of any of the above conditions? If so, please list them
Have you had any illnesses in the last 12 months? If YES, please give details
Do you have any allergies?
Do you have Arthritis, Asthma or Hernia?
Are you taking any prescribed medications? If YES, please give details
Are you receiving any treatment from a doctor, physiotherapist or other health professional? If Yes - What for?
Have you been hospitalized recently or given birth in the last 3 months?
Do you have any aches, pains, niggles or injuries to the following:
If YES, Please elaborate
If YES, Please elaborate
If YES, Please elaborate
If YES, Please elaborate
If YES, Please elaborate
If YES, Please elaborate
If YES, Please elaborate
Do you have any other medical problems or conditions we should know about prior to commencing an exercise program?
CONDITIONS OF TRAINING
THIS IS AN IMPORTANT DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS AND OBLIGATIONS. PLEASE READ CAREFULLY AND DO NOT SIGN UNLESS YOU UNDERSTAND IT. IF YOU HAVE ANY QUESTIONS, PLEASE ASK.
During your exercise program, every effort will be made to assure your safety. However, as with any exercise program, there are risks, including increased heart stress and the chance of musculoskeletal injuries. Part of your program will also include fitness testing which will enable a better assessment of your current fitness levels and provide a bench mark against normative tables to assist in setting realistic goals. By volunteering to participate in this program, you agree to assume the responsibility for these risks and waive any liability against EPIC WIN PT for personal damage.
Clearance from a medical practitioner is recommended for:
All participants with any limiting physical conditions or disabilities or a history of medical conditions (as indicated in your lifestyle screening and pre exercise questionnaire forms, which must be completed prior to signing this agreement.)
All men aged 45 and over and all women aged 55 and over
If you fall into these categories and have not gained an examination prior to exercise, by signing this form you acknowledge that you are aware of this recommendation and its importance.
By signing below you accept full responsibility for your own health and wellbeing whilst participating in your exercise program with EPIC WIN PT. You acknowledge and understand that no responsibility is assumed by the personal trainer or EPIC WIN PT in regards to any injuries resulting from participation in this training program. It is recommended that all program participants work with their personal trainer three times per week. However due to scheduling conflicts and financial considerations a combination of supervised and unsupervised workouts are possible.
PERSONAL TRAINING TERMS AND CONDITIONS
1. Personal training sessions that are not rescheduled or cancelled 24 hours in advance may result in forfeiture of the session and a loss of the financial investment at the rate of one session.
2. Personal training clients arriving late will receive the remaining scheduled session time, unless other arrangements have been previously made with our personal trainer.
3. The expiration policy requires completion of all personal training sessions within 6 months from date of payment. Sessions are void after this time period.
4. No personal training refunds will be issued without the authorisation from management, including but not limited to relocation and unused sessions.
5. Payments for individual and group personal training session packages are required upfront.
6. Payment options include: cheque, cash or direct deposit.
SCHEDULED GROUP SESSIONS
1. Clients are required to book their place in all scheduled sessions to enable time to plan suitable sessions for each group and also ensure adequate equipment is brought for all participants.
2. It is recommended that class passes be pre purchased to avoid transactions prior to each session.
3. No refunds will be issued for any reason, including but not limited to relocation and unused sessions/classes.
4. All participants must sign this agreement form and a pre exercise questionnaire prior to participation.
LEGALLY BINDING AGREEMENT
You understand that this agreement is legally binding in its terms and conditions, whether your use of the facility and its services is determined and paid for on a monthly, yearly, individual or complimentary visit basis. This agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and may be changed or added to only by a written amendment signed by both parties.
Do you agree to these terms and conditions?
Submit