Fitness Options | Online Training Enrollment Form

Welcome to Fitness Options online training! Fitness Options programs are developed and customized by certified fitness professionals. Programs vary in duration, intensity level and are designed to match your individual needs and goals. Please complete the following Enrollment Form to get started. Your baseline data will be evaluated by one of our certified personal trainers and we will contact you within 24 hours to get you started on the path to success.

Required fields are marked with an *

* Full name:

* Email:

Street address:

City:		State/Province:		Zip/Postal code:

Country:

How did you hear about us?

Area(s) of interest:

Personal training Nutrition guidance

Program Goals:

Strength Weight loss Endurance Flexibility

* Date of birth:

Height:

Weight:

lbs kg

% Body fat (if known):

Waist measurement:

in cm

Activity level:

Sedentary Moderate Exercise Athlete

Last time you exercised:

Areas of your body you want to improve the most:

Number of meals consumed per day:

Number of snacks consumed per day:

Food preferences:

Any specific goals?

* What equipment do you have available to you?

Full gym	Free weights	Flat Bench	Incline bench
Home gym	Physioball	Bosu	Medicine ball(s)
Treadmill	Stationary bike	Stepper	None

Other:

* Physical Activity Readiness Questionnaire (PAR-Q) — all questions are required

Have you ever had a heart attack or has a doctor ever said you have a heart condition?
Yes No

Do you experience any chest pain during physical activity?
Yes No

Has a Doctor ever recommended supervised physical activity?
Yes No

Have you ever lost consciousness or became dizzy while engaging in physical activity?
Yes No

Do you have any joint or bone injuries/pain that can be aggravated by physical activity?
Yes No

Do you know of any reasons either known by yourself or a doctor's advice that you should not exercise or engage in physical activity without medical supervision?
Yes No

* Health History — all questions are required

Heart attack	Yes	No
Lung/Pulmonary disease	Yes	No
Kidney/Liver disease	Yes	No
Neuromuscular disease	Yes	No
Diabetes	Yes	No
Pregnant	Yes	No

If yes, please explain:

I have read, understand, and answered all questions correctly to the best of my knowledge. I understand that a medical release form signed and dated by my physician may be needed prior to participating in any Fitness Options Program or activity.

* Full name:

Release of Liability

Participating in exercise programs created by Fitness Options involves the risk of injury to me. I understand that I may experience unusual sensations during or after an exercise session occurs. These may include joint and muscular injuries, dizziness or nausea. More severe risks include heart attack, stroke, paralysis, and other catastrophic injuries including death. I understand the risks involved, agree to participate and that Fitness Options, its members, employees, volunteers, agents, and independent contractors will not be held liable for any injury. I assume all responsibility to monitor my health and condition during the program designed by Fitness Options. If I notice any unusual symptoms or changes in my health, I will stop the program immediately and contact my physician and fitness professional.

* Full name:

If a physician's release is needed, Fitness Options will contact you regarding a physician medical clearance.

Your free consultation will not be processed until a physician releases you to participate in Fitness Options personal training programs and the physician release form is received by and reviewed by Fitness Options.