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Athlete Client Intake Form/Liability Waiver

Matthew Sechoka

Summit Strength Training LLC

1. Acknowledgment and Assumption of Risk

By checking the box at the end of this waiver, I acknowledge that I have voluntarily chosen to participate in strength training, coaching, or fitness programs provided by Matthew Sechoka and Summit Strength Training LLC (referred to as “the Company”).

I understand and agree that:

  1.  Participation in these activities involves inherent risks, including but not limited to:

  •  Muscle strains, sprains, or tears

  •  Joint injuries

  •  Spinal injuries

  •  Heart-related issues

  •  Other unforeseen physical injuries or medical complications

  2.  I am voluntarily participating in these activities and assume all risks, known and unknown, including those arising from negligence.


2. Release of Liability

In consideration of being permitted to participate in the Company’s programs, I agree to the following:

  1.  I release, discharge, and hold harmless Matthew Sechoka, Summit Strength Training LLC, and any affiliated trainers, employees, or contractors from all claims, demands, or causes of action related to any injury, loss, or damage sustained during participation.

  2.  This release applies even if injury or loss is caused in whole or in part by negligence of the Company or its representatives.

  3.  I agree to indemnify and defend the Company against any claims or legal action arising from my participation.


3. Medical Clearance and Personal Responsibility

  1.  I confirm that I am in good health and physically able to participate in strength training, fitness programs, or coaching.

  2.  I have consulted a medical professional about any pre-existing conditions, and I take full responsibility for disclosing such conditions to the Company.

  3.  In the event of injury or medical emergency, I authorize the Company to seek emergency medical care on my behalf at my expense.


4. Program Policies and Client Expectations

  1.  Payments: All fees are non-refundable unless otherwise stated. Payments must be made in advance or according to the agreed-upon schedule.

  2.  Cancellation Policy: Clients must provide at least 24 hours notice for cancellations or reschedules. Failure to do so may result in a forfeited session. "Banked" sessions must be used within 30 days of payment or they will be forfeited. 

  3.  Cancellation of Service: Clients are required to provide a minimum of 30 days written notice prior to canceling any ongoing coaching services or programs. Failure to provide written notice may result in the billing of one additional month of service. Acceptable forms of written notice must be email or delivered in person. 

  4.  Code of Conduct: Clients must follow instructions, use equipment safely, and maintain respectful behavior toward the Company and others. The Company reserves the right to terminate services for inappropriate or unsafe behavior.

  5.  Results Disclaimer: The Company does not guarantee specific results as progress depends on individual effort, adherence to guidance, and other factors.


5. Training Approach

  1.  Individualized Programming: Summit Strength Training LLC specializes in creating custom strength training programs designed to meet client-specific goals, including but not limited to strongman/powerlifting competition preparation, general fitness, or performance enhancement.

  2.  Progressive Overload: Training programs emphasize gradual increases in intensity and volume to ensure safe and sustainable progress.

  3.  Technique Focus: Clients will receive instruction on proper lifting techniques to maximize results while minimizing injury risk.

  4.  Client Commitment: Active participation, consistency, and adherence to prescribed programs are necessary for success. If you're doing online coaching and do not complete the workouts on a weekly basis, due to anything other than a hardship or sickness, you will still be billed weekly regardless of participation. I'm doing my job, you need to do yours. 

  5.  Open Communication: Clients are encouraged to discuss concerns, injuries, or modifications to ensure the program remains effective and safe.


6. Data Privacy and Confidentiality

  1.  Data Collection: Summit Strength Training LLC may collect and store personal information such as contact details, health history, and progress metrics to deliver personalized services.

  2.  Data Usage: Personal information will be used solely for the purposes of program customization, tracking progress, and communication.

  3.  Confidentiality: All client information will be kept strictly confidential and will not be shared with third parties without explicit written consent, except where required by law.

  4.  Digital Platforms: If online coaching platforms, apps, or email communications are used, the Company will take reasonable measures to protect data security but cannot guarantee against breaches outside its control.


7. Media Release

I grant Summit Strength Training LLC permission to use photographs, videos, or testimonials from my participation for marketing, promotional, or educational purposes. I waive any compensation or rights of ownership to these materials.


8. Governing Law and Dispute Resolution

  1.  This agreement shall be governed by the laws of the state of Massachusetts.

  2.  Any disputes shall first be resolved through mediation before seeking further legal action.


9. Severability

If any provision of this agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.


10. Payment Policy

Payment requests are issued one week in advance to ensure accounts remain current. Accepted payment methods are Venmo or cash. If paying with cash, payment must be made several weeks in advance to secure your spot.


11. Acknowledgment of Understanding

By checking the box below, I confirm that I have read, understand, and voluntarily agree to this Liability Waiver and Terms of Service. I am at least 18 years old or have a legal guardian co-sign this agreement if under 18.

I confirm that I have read, understand, and voluntarily agree to this Liability Waiver and Terms of Service.



By digitally signing below and submitting this form, I acknowledge that strength training and anything that involves physical activity carries inherent risks. I agree to follow all coaching instructions and take responsibility for my own safety. I release Summit Strength Training and its coaches from any liability for injuries sustained during training.


First Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
By checking this box, you agree to receive text message updates from the business who owns this Smartwaiver form. Msg & data rates may apply. Msg frequency is recurring. Reply STOP to opt out.
Select Gender
First Athlete/Client Date of Birth*
Date of Birth
First Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
First Athlete/Client Signature*
Second Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Second Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Second Athlete/Client Signature*
Third Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Third Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Third Athlete/Client Signature*
Fourth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Fourth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Fourth Athlete/Client Signature*
Fifth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Fifth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Fifth Athlete/Client Signature*
Sixth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Sixth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Sixth Athlete/Client Signature*
Seventh Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Seventh Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Seventh Athlete/Client Signature*
Eighth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Eighth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Eighth Athlete/Client Signature*
Ninth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Ninth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Ninth Athlete/Client Signature*
Tenth Athlete/Client Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Athlete/Client Date of Birth*
Date of Birth
Tenth Athlete/Client Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
Tenth Athlete/Client Signature*
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
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*
Middle Name
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Intake Questions
What are your primary fitness goals?
Have you worked with a coach before (yes/no) and tell me about your experience.
How long have you been training?
Do you have any current or past injuries that impact training? If no, write in "n/a"
Do you have any medical conditions that affect exercise? If so, please be specific. If not, write n/a.
Are you currently taking any medications that may impact your training? If not, just answer with "n/a"
How many days per week do you currently train? What do you do during those days?
What is your occupation and where?
Approximately how many hours of sleep do you get per night?
How would you rate your stress level? 1 is very low, 5 is very high.
Do you follow a specific dietary approach? If so, what does that look like?
Do you take any supplements daily? If so, what do you take?
Do you track your nutrition? Yes or no. If yes, what method/app do you use?
What do you expect from this coaching experience?
If you want online coaching and aren't training at my gym, will you be willing to get me a list of every piece of equipment that you have access to?
Do you have access to specialized equipment if you are interested in online coaching for strongman or powerlifting?
Are you ready to kick some ass? You better answer YES!
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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