Personal/Athletic Training Agreement

Transcription

1 Personal/Athletic Training Agreement Standard Fitness Training ½ Hour Session Total Package Cost Price Per Session Expiration Terms Packages 10 Sessions $300 $30.00 Sessions expire 10 weeks 20 Sessions $550 $27.50 Sessions expire 12 weeks Hour training session package costs are double the half hour price. Monthly Packages Total Package Cost Price Per Session Expiration Terms 2 Sessions per week $225 $25.00 Sessions expire week to 3 Sessions per week $312 $24.00 Sessions expire week to 4 Sessions per week $391 $23.00 Sessions expire week to 5 Sessions per week $462 $22.00 Sessions expire week to Hour training session package costs are double the half hour price. Elite Fitness Training Premium services include: Baseline- testing depending on the clients goals (i.e. measurements, body fat percentage, functional movement screen) Constant heart rate monitoring throughout sessions Slow- motion video analysis and instruction for all sports Nutritional consultation including 3 month meal plan ½ Hour Session Packages Total Package Cost Price Per Session Expiration Terms 10 Sessions $375 $37.50 Sessions expire 10 weeks 20 Sessions $700 $35.00 Sessions expire 12 weeks

2 CLIENT INFORMATION First Name: Last Name: Address: City: State: Zip Code: Home Phone: Cell Phone: Date of Birth: Has your doctor cleared you to exercise (please circle one): YES NO Do you have any past/previous injuries (please circle one): YES NO If yes, please describe: Do you have any current health conditions (please circle one): YES NO If yes, please describe: Health information/concerns that needs to be disclosed prior to starting an exercise program: Emergency Contact Information: Name Home Number Relationship Cell Phone Signature Date ExerVolve Representative

3 Consent Form 1. E- MAIL RISKS AND YOUR RESPONSIBILITY At the discretion of ExerVolve, its employees and agents and upon your agreement to the terms outlined within this consent form, ExerVolve may use e- mail to communicate with you. These e- mails may contain your personal health information. If you agree to permit ExerVolve to use e- mail to communicate with you, you should be aware of the following risks and/or your responsibilities: 1. a) As the Internet is not secure or private, unauthorized people may be able to intercept, read and possibly modify e- mail you send or are sent by ExerVolve. 2. b) You must protect your e- mail account, password and computer against access by unauthorized people. 3. c) Since e- mail can be used to spread viruses, some which cause e- mail messages to be sent to people who you do not intend to send e- mail messages to, you should install and maintain virus protection software on your PC. 4. d) Since e- mails can be copied, printed and forwarded by people to whom you send e- mails, you should be careful regarding whom you send e- mails. 2. CONDITIONS FOR THE USE OF E- MAIL By consenting to the use of e- mail with CHP, you agree that: 1. a) ExerVolve employees, other than the recipient, may have access to e- mails that you send. Such access will only be to such persons who have a right to access your e- mail to provide services to you. Otherwise, ExerVolve will not forward e- mails to independent third parties without your prior written consent, except as authorized or required by law. 2. b) Although Exervolve will try to read and respond promptly to your e- mails, ExerVolve staff may not read your e- mail immediately. Therefore, you should not use e- mail to communicate with ExerVolve if you require an answer in a short period of time. 3. c) If your e- mail requires or asks for a response, and you have not received a response within a reasonable time period, it is your responsibility to follow up directly with ExerVolve. 1. Acknowledgement: I understand and agree that e- mail communication is not perfectly confidential, and I assume all risks that it may present, including without limitation, hacking, electronic interruption or interception by persons known or unknown, local or not, the distribution of personal information so gained on the internet, and any other risk to my privacy, personal information or other e- mail communication. By signing this form, and using e- mail to communicate with ExerVolve and staff, I acknowledge that I have read, understand, and freely accept the risks of using e- mail as means of communication, and agree to follow the above procedures for e- mail communication. I understand and agree that failure to follow the rules may result in a permanent refusal by the ExerVolve staff to communicate with me via this medium.

4 I hereby agree to accept and be legally bound by this Personal Training Contract. By signing this document, I attest, contract, acknowledge, and agree that I am legally bound by its content. INFORMED CONSENT FOR AN EXERCISE TEST EXPLANATION OF THE EXERCISE TEST: I understand that I will perform an exercise test. The exercise intensity will change throughout the course of the evaluation. You may stop the test at any time because of signs of fatigue, changes in your heart rate, and/or blood pressure. I understand that I may stop whenever I wish because of feelings of fatigue or any other discomfort. ATTENDANT RISK AND DISCOMFORTS: There exists the possibility of certain changes occurring during the test. They include abnormal blood pressure, fainting, irregular, fast or slow heart rhythm, and in rare instances, heart attack, stroke, or death. I understand that every effort will be made to minimize these risks by evaluation of preliminary information relating to my health and fitness and by observation during testing. RESPONSIBILITIES OF THE PARTICIPANT: I understand that information I possess about my health status or previous experiences of unusual feelings with physical effort may affect the safety and value of my exercise test. I acknowledge that my prompt reporting of unusual feelings during the exercise test itself is extremely important and that I am responsible for fully disclosing such information whether or not requested by the testing staff. BENEFITS TO BE EXPECTED: I understand that results obtained from the exercise test may assist in evaluating what type of physical activities I might do with low risk and be used as a guideline for my fitness level progression. INQUIRIES: I acknowledge that questions about the procedures used in the exercise test or the results of my test are encouraged. If I have any concerns or questions, I understand that I should ask for further explanations. FREEDOM OF CONSENT: My permission to perform this exercise test is voluntary. I understand that I am free to stop the test at any point, if I desire. I consent to participate in this test. By signing this document, I attest, contract, acknowledge, and agree that I am legally bound by its content. PRICING AND PAYMENT I acknowledge and agree that this Personal Training Contract is not transferable or assignable. I acknowledge that payment is required for blocks of sessions in advance of actual training sessions. I agree to pay in advance for training sessions. I understand this money is not refundable. I understand this contract and the terms it

5 presents is for the purchase of sessions and any other purchase of services in the future. I acknowledge that this specific contract, release of liability, consent, and agreement is continuously valid indefinitely. I understand that a minimum requirement of one session per week must be completed or I will be charged for the session(s) missed. No refund will be granted for sessions that have not been completed. I understand ExerVolve has the right and the authority to terminate the program at any time, with no refund, if I do not follow the program or fail to conduct myself in an appropriate manner. By signing this document, I attest, contract, acknowledge, and agree that I am legally bound by its content. CANCELLATION AND LATENESS I acknowledge that appointment times are reserved and that cancellations must be made 24 hours in advance. Cancellations must be made by calling (voic will record date/time). I understand that I will not receive a refund for missed appointments. It is my responsibility to attend my personal training appointments when they are scheduled. I understand that appointments will begin and end promptly as scheduled. I acknowledge that any delays to the start of a scheduled appointment will not be a cause of extend provided service beyond the remainder of the scheduled time. I will not expect or ask my trainer to run overtime. I understand that if I am 15 minutes late my session will be canceled and I will be charged for that session. I understand that sessions will run approximately one half hour or one hour unless otherwise stated. I acknowledge that a delay to a scheduled session cannot change the session status to anything else except a whole session. I understand that there are no half sessions because of any delay. By signing this document, I attest, contract, acknowledge, and agree that I am legally bound by its content. Agreement of Release of Liability 1. In consideration of being allowed to participate in the activities and programs of ExerVolve and to use its facilities, equipment and machinery, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge ExerVolve and its directors, officers, agents, employees, representatives, successors and assigns, administrators, executors, and all others from any and all responsibilities or liability from injuries or damages resulting from my participation in any activities or my use of facilities, equipment or machinery in the above mentioned activities. I do also hereby release all those mentioned and any others acting upon their behalf from negligence of the program or any of its agents due to any such ordinary negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising

6 out of or connected with my participation in any activities of ExerVolve or the use of any facilities/equipment or machinery at ExerVolve. I acknowledge and understand that this release is given in advance of any injury or damage to me and that it includes injury or damage to me caused by the ordinary negligence of those released hereby but not from any claims related to gross negligence or willful/wanton/criminal/intentional conduct or acts of those who are otherwise released hereby. 2. I understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I also understand that fitness activities involve the risk of injury and even death, and that I am voluntarily participating in these activities and using facilities, equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death. 3. I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or machinery except as hereinafter stated. I do hereby acknowledge that I have been informed of the need for a physician s approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of exercise and training equipment so that I might have his/her recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and have been given my physician s permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. This Agreement shall be binding upon the undersigned, his/her heirs, executors, administrators and assigns. Date Signature Signature of ExerVolve representative: