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Client Responsibilities:

  • Complete a Health History Form and Personal Training Agreement form. 
    • I acknowledge that I will complete the questionnaire, accurately completely, and to the best of my knowledge. Also, if my health status changes, I am responsible for informing my trainer of any change in my medical condition and/or any recent injuries. 
  • Agrees to allow trainer to contact Client’s personal physician’s office to obtain exercise clearance approval and/or authorizes Physician to release pertinent medical information he/she deems necessary that is pertinent for an exercise program.
  • I acknowledge that I have either had a physical examination, and have been given my physician's permission to participate, or that I have decided to participate in the activities and/or use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. 
  • Will provide trainer/instructor at least 24-hours notice to reschedule any appointments. 
  • Please arrive 5 to 10 minutes prior to your scheduled appointment to complete the required warm-up. 

Scheduling & Fees:

  • All sessions are for the pre-booked duration beginning at the scheduled time. In the event of client tardiness, trainers are not responsible for extending sessions past appointed times as this would interfere with other client schedules. Fees will not be prorated for client tardiness, nor will time be made up. All members and guests may purchase personal training sessions at The Sea Pines Resort Fitness Center. We accept the following forms of payment: cash or credit cards. In addition you may place charges on your room account if staying with The Sea Pines Resort.
  • All personal training packages will expire 6 months from purchase date. 
  • Sessions must be used within the allotted times. Please discuss any scheduling conflicts you have with your trainer as soon as possible and within the 6 month period. The trainer is not responsible for issuing a refund for unused times

​Cancellation Policy: 

  • Client agrees that a 24-hour notice is required to cancel a personal training session. Client further agrees, by signature below, to be charged the full amount for said session in the event 24 hour notice is not provided

We look forward to working together with you to achieve your health and wellness goals.

I have read, understood and agree to The Sea Pines Resort Personal Training Agreement.

I Agree
July 24, 2021

 Agreement and Release of Liability

  1. In consideration of being allowed to participate in the exercise/fitness activities and programs of The Sea Pines Resort and to use its exercise/fitness facilities, equipment, and machinery, in addition to the payment of any fee or charge, if any, I do hereby waive, release and forever discharge Sea Pines Resort, LLC and their officers, agents, employees, representatives, executors and all others from any and all responsibilities or liability for injuries or damages resulting from my participation in any activities at said fitness facility.  I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability or any injury or damage myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any fitness center activities of Sea Pines Resort, LLC or the use of any exercise/fitness equipment at The Sea Pines Resort. 
  2. I understand and am aware that strength, flexibility, and aerobic exercise, including the use of exercise/fitness equipment, are potentially hazardous activities. I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using such equipment and machinery with full knowledge of the dangers involved.  I hereby agree to expressly assume and accept any and all risks of injury or death.
  3. I do hereby further declare myself to be physically sound from any condition, impairment, disease, infirmity, or other illness that would prevent my participation in any of the fitness/exercise activities and programs of The Sea Pines Resort or use of fitness equipment or machinery except as hereinafter stated.  I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery.  I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have recommendations concerning these fitness activities and equipment use.  I acknowledge that I have either had a physical examination, and have been given my physician’s permission to participate, or that I have decided to participate in the activities and/or use of equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. 

 

 

Participant's or Parent of Minor Signature  

Date Completed July 24, 2021

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant's 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's Name*

Emergency Contact's Phone Number*
The questions below are used to access your health status. Please check all the statements that are true.
Health History - Please check any that apply:
A heart attack
Cardiac catheterization
Congenital heart disease
Coronary angioplasty (PTCA)
Defibrillation/rhythm disturbance
Heart failure
Heart surgery
Heart transplantation
Heart valve disease
Pacemaker
Personal history of metabolic disease (thyroid, renal, liver)
Nothing

Are there any health symptoms you've experienced?

Symptoms you may experience
Ankle edema
You experience chest discomfort with exertion
You experience dizziness, fainting, or blackouts
You experience unreasonable breathlessness
You have a heart murmur
You take heart medications

Please check any that may apply

Other Health Issues
You are pregnant
You have asthma or other lung diseases
You have burning or cramping sensation in your lower legs when walking short distances
You have diabetes
You have had a stroke
You have musculoskeletal problems that limit your physical activity
You take prescription medicine

Please check any that may apply

Cardiovascular Risk Factors
You are 20 pounds overweight
You are a man older than 45 years
You are a women older than 55 years, have had a hysterectomy, or are postmenopausal
You are physically inactive (ie, you get less 30 minutes of physical activity on at least 3 Days/week)
You do not know your blood pressure
You do not know your cholesterol level
You have a close blood relative who had a heart attack or heart surgery before age 55 (father or brother) or age 65 (mother or sister)
You smoke, or quit smoking within the previous 6 months
You take blood pressure medication
Your blood cholesterol level is above 200 mg/dL
Your blood pressure is above 140/90 mm Hg
Medical Health and Lifestyle Questionnaire
Have you had any of these?
Abnormal chest X-Ray
Arthritis
Back problems
Balance problems
Bursitis
Chronic headaches or migraines
Epilepsy or seizures
Ever had abnormal EKG
Foot problems
Hernia/ Anemia
Knee problems
Limited range of motion
Low blood pressure
Persistent fatigue
Recently broken bones
Shoulder problems
Stomach problems
Swollen painful joints

Have you had surgery in the past three months? If so, what kind?

Has a doctor imposed any activity restrictions? If yes, please explain:

Do you have any medical issues that were not mentioned above that you feel we should be aware of? If yes, please list:

Please list any medications you are currently taking (explain reasons for taking medications):
Exercise History

To create a personalized exercise and activity plan, it is important for us to understand your personal history of exercise. This information will help us to recommend appropriate exercises as well as their frequency and intensity. 

How would you rate your current physical activity level?*
Please check the activity that you enjoy participating in
Aerobics
Biking
Elliptical cross trainer
Golf
Other
Pilates
Running/Jogging
Skiing
Swimming
Tennis
Walking
Water aerobics
Weight training
Yoga

What types of physical activity have you participated in the last three months and how often do you perform them?

Do you have any orthopedic issues that would prevent you from walking on a treadmill? If so please describe.

Do you have any orthopedic issues that would prevent you from riding on a stationary bike? If so please describe.
Have you ever trained with a personal trainer before?*
No
Yes
Do you plan to exercise in the gym, at home or both?*
Gym
Home
Both

Please list any exercise equipment you have at home and plan to use.
Exercise Interests
Floor exercises for home
Free weights
Pilates/Yoga classes
Strength and stretching classes
Strength machines
Water aerobic classes
Personal Wellness Goals

In striving to achieve a higher state of wellness or fitness, a set of clearly defined goals is essential.

Please check specific goals:
Decrease body fat
Feel better
General fitness
Improve balance
Improve diet
Improved coordination
Increase cardiovascular fitness
Increase energy
Increase flexibility
Increase muscle tone
Increase strength
Injury prevention
Lose weight
Reduce back pain
Reduce stress
Sleep better
Sports specific
Stop smoking
Motivation Level*

What is motivating you to begin an exercise program?

Using the SMART principle design three short term and long term goals. Goals need to be specific, measurable, attainable, realistic, and time sensitive.


1st Short Term Goal *

2nd Short Term Goal *

3rd Short Term Goal *

1st Long Term Goal *

2nd Long Term Goal *

3rd Long Term Goal *
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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