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Client Information Form
Nameyour full name
Address
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Gender
Phoneyour phone number
Birthdate
I'm interested in...check as many as are applicable
Emergency Contact
Nametheir full name
Relationshipto you
Phonetheir phone number
About You & Your History
These questions are purely informational and are used to help us build a customized workout plan for you.
Your Ageyour full name
Do you have any known family history of heart conditions or sudden death?
Any more details would be much appreciated & very helpful.more details
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Have you smoked a cigarette in the past 6 months?
Do you currently exercise 3 or more days per week?
Do you have a BMI of 30 or above?

Don't know your BMI? Visit SemposeFitness.com/BMI for a free calculator.

Is your blood pressure 140/90 or higher?
Is your LDL (Cholesterol) 130 or higher?
Do you know your glucose levels?
Mind telling us what your glucose levels are?
In terms of exercise, how active are you currently?pick one!
How long has it been since you last exercised?your full name
How well would you say you know your way around a weight room?pick one!
Do you have a preference for a certain type of lifting (ex: free weights, bodyweight, machines, elastic bands)? Dislikes? Feel free to describe here.more details
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Do you have access to exercise equipment?pick one!
Do you have children?
Do you have someone who would work out with you at home/gym?
How much time per day are you willing to commit to exercise?more details
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Do you have a dog (or dogs)?
Do you have sidewalks or a walking trail near your home/place of residence?pick one!
How would you rate your eating habits? (On a scale from 1-10, 1 being terrible, 10 being "awesome.")
1
0
10
Have you ever tracked what you eat?
Do you have a preferred method of cardiovascular training (ex: bike, running, elliptical, group classes)? Any dislikes? Feel free to describe here.more details
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What does your typical day look like (ex: sitting all day, a lot of walking, biking to class, stairs v.s. elevator)?more details
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Can you think of any specific skill(s) that you would like help improving?
Mind telling us what? (If not, we can chat in person.)your full name

In these next sections, feel free to write as much or as little as you are comfortable.

Any previous injuries that you are NOT having problems with? Feel free to describe here.more details
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Any injuries that you ARE CURRENTLY having problems with? Feel free to describe here.
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Any exercises you've done in the past that have caused pain? Any that you have had trouble performing in the past?more details
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Any exercises that have caused you trouble in the past that you would really like to be able to do?more details
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What inspired you to take advantage of training with Sempose Fitness and what do YOU expect to get out of it?more details
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What do you expect from your trainer?more details
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What type of training/encouragement do you prefer?more details
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Do you have any areas or joints that you would like increased flexibility in? If so, which ones?more details
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What type of endurance training, if any, are you currently doing?more details
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Any short term goals?more details
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Long term or end goals?more details
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Waiver, Release, & Assumption of Risk Form

This form is an important legal document. It explains the risks you are assuming by participation in an exercise program. It is important that you read and understand it completely. After you have done so, please type your name and sign in the spaces provided at the bottom.

Waiver, Informed Consent, and Covenant Not to Sue

I have volunteered to participate in a physical exercise regimen under the direction of Sempose Fitness LLC, which will include, but may not be limited to, weight and/or resistance training. In consideration of Sempose Fitness LLC’s agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold harmless Sempose Fitness LLC, and their respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT AND (3) OUR NEGLIGENT INSTRUCTION OR SUPERVISION.

Assumption of Risk

I realize that exercise might be difficult and strenuous and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain unusual physical changes during exercise does exist. These changes include abnormal blood pressure; fainting; disorders in heartbeat; heart attack; and, in rare instances, death. I understand that as a result of my participation, I could suffer an injury or physical disorder that could result in my becoming partially or totally disabled and incapable of performing any gainful employment or having a normal social life. I recognize that an examination by my physician must be obtained prior to involvement in this exercise program. I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST Sempose Fitness LLC, or OTHERS REFERRED TO IN THIS DOCUMENT FOR ANY NEGLIGENCE OR THAT OF OUR EMPLOYEES, AGENTS, OR CONTRACTORS.

Photography and Audio/Video Recording

I hereby give Sempose Fitness LLC and Sempose Fitness LLC’s recording staff permission to video tape, photograph, and record my image and or likeness. I understand that such taping or recording may be used at the sole discretion of Sempose Fitness LLC. I also understand by giving permission is in no way an endorsement of Sempose Fitness LLC or any product(s) distributed by Sempose Fitness LLC.

Nameyour full name

By checking the following box and typing your name in the following space, you affirm that you have read and understand all of the information presented above.

I acknowledge that typing my name in the box below constitutes my legal signature and is binding as such.
Your E-Signature
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