Client Questionnaire Client Form Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth(Required) MM slash DD slash YYYY Emergency Contact(Required) First Last Emergency Contact Phone(Required)How Did You Hear About Us?(Required) Terms & ConditionsPersonal Training Program PoliciesEach Participant must sign a waiver and complete health history questionnaire (PAR-Q) to be kept on file and will be confidential between the personal trainer and the client. Participants must give a 24 hour notice in advance for cancellations; if notification is not at least 24 hours in advance, or the session is missed the participant will be charged for the session. Release of Liability-Assumptions of Risk-Buyers Right to Cancel Your participation in the Personal Training Program naturally involves the risk of injury, whether you or someone else causes it. As such, you understand and voluntarily accept this risk and agree that Freeform Fitness and the facility used will not be liable for any injury, including without limitation, personal, bodily or mental injury, economic loss or damage to you, your spouse, guest, unborn child, or relatives resulting from the negligence or other acts of Freeform Fitness or anyone on Freeform Fitness behalf or anyone else in the program or using the facilities. Further, you understand and acknowledge that Freeform Fitness does not manufacture any of the fitness or other equipment used, but purchases and/or leases equipment from third parties. As such, you understand and acknowledge that Freeform Fitness is providing recreational services and may not be held liable for defective products. If there is any claim, by any one, based on any injury, loss or damage described here, which involves you or your guest, you agree to release Freeform Fitness against any claims indemnify Freeform Fitness for all liabilities to you and your spouse, guest, relatives or anyone else, resulting from such claims. I understand and agree to the Terms & Conditions(Required) I have read the Terms & Conditions and received the Physical Activity Questionnaire (PAR-Q) FormDate MM slash DD slash YYYY Signature(Required)This agreement is not effective until it is signed and dated by you and an authorized Freeform Fitness representative. By signing below, you agree to all the terms of this agreement. CAPTCHANameThis field is for validation purposes and should be left unchanged.