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NEW STUDENT PACKET

**You're not signing up for anything, just acknowledging our polices if you do.**




PARTICIPANT RELEASE AND KNOWLEDGE OF AGREEMENT 

I wish to participate in the exercise and training program offered by Renu Health & Fitness. I understand there are inherent risks in participating in a program of strenuous exercise including but not limited to, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/ foot injuries and any other illness, soreness, or injury however caused, occurring during or after participant participation in the physical activities. I further acknowledge that such risks include, but are not limited to, injuries caused by the negligence of an instructor or other person, defective or improperly used equipment, over exertion, slip or fall by myself, or an unknown health problem of mine. I agree to assume all risk and responsibility involved with participation in the physical activities, I affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit participation in the physical activities.


By signing I assert that I can participate in physical activities. I agree to assume all risk and responsibility for not exceeding my physical limits. I also understand photos and or video may be taken during my involvement, which may be used for promotional purposes.


I agree that Renu Health & Fitness, Dino Nowak, Nowak Enterprises, it’s employees, contractors, officers, or owner/s..., shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge the above from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program. This Release shall be binding upon my heirs, executors, administrators and assigns.


I have read and understand this term:


I certify that the answers to the questions outlined on the PAR-Q form are true and complete to the best of my knowledge. I understand and agree that it is my responsibility to inform my Trainer of any conditions or changes in my health, now and ongoing, which might affect my ability to exercise safely and with minimal risk of injury.


I have read and understand this term: 


I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my coach right away.


I have read and understand this term:


I understand that all Semi-Private Training rates are based on 45 minute sessions and should I arrive late, there is no guarantee I will receive the full session with my coach.


I have read and understand this term: 


I understand that Renu Health & Fitness operates on a scheduled appointment basis for all Training sessions and thus, requires that I register at least 2 hours before the session time. For 7am sessions registration by 8pm the night before is required to ensure a coach is provided. If I am unable to attend a session I will cancel through the scheduling system.


I have read and understand this term: 


I understand that the usage of any nutritional supplements is done under my own will and has not been prescribed by my coach.


I have read and understand this term: 


I understand that Renu Health & Fitness operates on a scheduled appointment basis for all Private coaching sessions and thus, requires that I provide 24 hours’ notice when canceling an appointment. No charge will be levied should I cancel with MORE than 24 hours’ notice given


I have read and understand this term:



To keep our members safe you agree not to wear socks on the concrete floors which could cause a slip and fall. If doing Yoga go barefoot or wear socks with a working grip on the bottom. By initialing you understand this risk and agree to release and hold harmless Renu, Dino Nowak and any and all associated entities and their officers.


I have read and understand this term:



All monthly and weekly programs with the exception of the 6 week paid in full program, will automatically renew upon their completion and shall be considered active until cancelled as described in the Cancellation policy below:

Renu Policies

CANCELLATION POLICY (Month to Month Programs): Renu member agrees to give notice of cancellation by Email to info@RenuHealthandFitness.com at least 5 business days from billing date of new term (your billing date is the date of your first payment). (Please note…Notifying your coach does not count)

I have read, understand and accept this term:


PERFURMES and SHOES: Please refrain from heavy use of perfumes or colognes, better to not wear at all. Some members have medical conditions and for others it can be overwhelming. Also please wear clean shoes free from mud and other debris including animal poop. Its on here for a reason, we've had people unknowingly bring it in. Best to have a pair of shoes you just use for indoor training. We try to provide a clean environment for our members, all of us can play a part.

I have read, understand and accept this term:



MEMBERSHIP FREEZE: Included with all Memberships are 1 month of freeze time every 12 consecutive months in the event member is out sick, traveling or just wishes to take a break. During this month member dues are reduced by 50% for that one month.

Short term absences are priced into the membership and member has full access to the schedule to make up sessions within the month. If attendance will be inconsistent we offer a pay as you go 10 pack option. Discount given with monthly memberships is in exchange for consistent billing.

Any programs that have a rate lock must be used to maintain rate lock, if not, member upon returning will enter at current rates.

**To Freeze: Email info@RenuHealthandFitness.com at least 3 days before to request freeze dates. Freezes cannot be done retroactively. **

I have read, understand and accept this term:



REFUNDS AND UNUSED SESSIONS: Members have a 30day period in which to try Renu, if they deem training at Renu is not a good fit within those first 30days AND have actually tried it attending at least 8 sessions within the month they may cancel and receive a full refund. Member understands and agrees there are no refunds for any unused time or sessions after their first 30 days at Renu regardless of reason including medical. Renu uses those funds to pay staff and facility rent whether member shows or not. Unused sessions do not roll over and must be completed within that billed month. If attendance will vary or will not be consistent, we recommend purchasing instead a 10 pack pay as you go package that is good for one year.

I have read, understand and accept this term:


Date: October 30, 2024









First Students Name

First Name*

Last Name*

Phone*
First Students Date of Birth*
First Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
First Students Signature*
Second Students Name

First Name*

Last Name*
Second Students Date of Birth*
Second Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Third Students Name

First Name*

Last Name*
Third Students Date of Birth*
Third Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Fourth Students Name

First Name*

Last Name*
Fourth Students Date of Birth*
Fourth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Fifth Students Name

First Name*

Last Name*
Fifth Students Date of Birth*
Fifth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Sixth Students Name

First Name*

Last Name*
Sixth Students Date of Birth*
Sixth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Seventh Students Name

First Name*

Last Name*
Seventh Students Date of Birth*
Seventh Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Eighth Students Name

First Name*

Last Name*
Eighth Students Date of Birth*
Eighth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Ninth Students Name

First Name*

Last Name*
Ninth Students Date of Birth*
Ninth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Tenth Students Name

First Name*

Last Name*
Tenth Students Date of Birth*
Tenth Students Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Students Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact:

Emergency Contact: *

Relationship: *

Phone Number: *
Par Q Form
Has your Doctor ever said you have a heart condition and recommended only medically supervised physical activity?*
No
Yes
Do you frequently have pains in your chest when you perform physical activity?*
No
Yes
Have you had chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance DUE to dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone, joint or any other health challenge that causes you pain or limitations that must be addressed when developing an exercise program? (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, shoulder, knee or back pain)*
No
Yes
Have you had a recent surgery?*
No
Yes

If you marked yes to any of the above, please elaborate below *
Do you take any medications, either prescription or non prescription on a regular basis?*
No
Yes

If so what is the medication for?

Is there anything else we should know that could impact your ability to engage in physical activity?
Lifesytle Related Questions
Do you smoke?*
No
Yes

If yes, how many per day on average?
Do you drink alchohol?*
No
Yes

If yes how many glasses per week?

How many hours of sleep do you average per night?
Describe your job*
Sedentary
Active
Physically Demanding
Does your work require travel?*
No
Yes

On a scale of 1-10 how would you rate your stress level. (1=very low 10=very high)

What would you say are your 3 biggest areas of stress
Fitness History

When were you in the best shape of your life? What were you doing?
Have you been exercising consistently for the past 3 months?*
No
Yes

In what ways is your daily life impacted by your current health and fitness level? *

How long have you been thinking about making a change in your health?

On a scale of 1-10, how would you rate your present fitness level (1=Worst 10=Best)?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please complete and return. 

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your coach develop a program that addresses your needs, goals and interests and is safe and effective. 


Music you like to exercise to: *

Favorite Musicians:

Occupation:

T-Shirt Size *

Physician's Name:

Physician's Phone:

Physician's Address if known:(Street / City / State / Zip Code)
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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