Name *

First Name

Last Name

Which training option are you interested in? *

Check all that apply

Online Personal Training

In-Person Personal Training

Hybrid (both online & in-person) Personal Training

Deca Program

What is the best way to communicate with you? *

Check your most preferred method, please

Phone Call

Text Message

Email

Carrier Pigeon (Kidding...)

Please rate your level of stress while at work *

1 is low stress and 5 is high stress

1- Low

2

3

4

5- High

**Waiver Agreement**

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 a risk of injury and even death, and I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept all risks of injury or death. I do by 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 stated hereinafter stated. I acknowledge that I have been informed to receive a physician’s clearance and have been recommended that I receive 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 been given my physicians 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.

By checking this box you agree to the statements above