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Waiver & Exercise Readiness
Exercise Readiness Questionaire
Name
*
First
Last
Email
*
What is your workout history?
*
I've been active for a while.
I go through phases of working out.
I used to be active, but not recently.
I don't work out, which is why I am here!
Other
If Other please specify:
*
Why are you interested in personal training?
*
I am training for a specific event and need an extra kick in the rear.
I am too set in my routine and need to shake things up.
I need someone to show me what to do.
I need the support and accountability!
Other
If Other please specify:
*
On a scale of 1-5, how motivated are you to get started?
*
1- I'd rather go back to bed.
2 - I'll do it if I have to.
3 - I may not always smile about it, but I'll do what I gotta do.
4 - I'm ready to get moving most days, I just need an extra push.
5 - I am BEYOND ready. Let's GO!
Any previous illness or injury I need to be aware of?
*
If you have been diagnosed by a MD for anything, please tell me here. I may require medical clearance from your Primary Care physician for certain conditions. I must know any necessary precautions we must take before beginning a workout regimen. Failure to provide important medical information forfeits any claims or causes of action that may be held against Jennifer Raby and JenRabyFitness.
What is your age?
*
Under 18
18-24
25-34
35-50
51-60
Over 60
Any interested participants under the age of 18 must have a waiver signed by a parent or legal guardian and a medical clearance form. I will require the parent or guardian to be present for the first training session. I am not currently taking clients under the age of 15.
Have you worked with a trainer before? What did you like? What didn't you like?
*
What is the number one, absolute most important thing personal training should do for you?
*
Share here anything else you'd like me to know about you and the training experience you would like to have!
Submit
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