Training Intake Form 

Today's date *
Today's date
Name *
Name
Gender *
Birthday *
Birthday
Stress level *
Are you currently pregnant? *
*Required for women only to answer
Do you smoke? *
How ready are you to make the necessary changes to reach your goal? *
Liability Agreement *
I agree that if I engage in any physical exercise or activity, including personal training, I do so at my own risk and assume the risk of any and all injury and/or damage I may suffer, whether while engaging in physical exercise or not. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) my use of any exercise equipment or facilities which may malfunction or break, (b) improper maintenance of any exercise equipment, premises or facilities, (c) negligent instruction or supervision, including personal training, and/or (d) slipping or tripping and falling while on any portion of a premises or while traveling to or from personal training, including injuries resulting from Astrid Bengtson's or anyone else’s negligent inspection or maintenance of the facility or premises. By checking the "I agree" box below, I hereby agree to indemnify and hold harmless Astrid Bengtson from any loss, liability, damage, or cost Astrid Bengtson may incur due to the provision of personal training by Astrid Bengtson to me.