SMARTGOLF New Member Form
Email address *
Basic Information
Name *
Your answer
Date of Birth *
Phone Number *
Your answer
Your answer
Your answer
Right or left handed? (General) *
Right or left handed? (Golf Swing) *
How did you hear about us? *
Name of person that referred you to us (if applicable)
Your answer
Your Golf Game
The state of your game as it is right now.
What's your previous experience with golf instruction? *
Your answer
Years played *
Please further describe your experience with golf (ex: been playing for 10 years, but only seriously for the last 2 years)
Your answer
Have you been fit for your clubs? *
Current Handicap
Your answer
Average Score
Your answer
Lowest Handicap
Your answer
Lowest Round
Your answer
Rounds per week (in season) *
Practice per week (not including pre-round warm-ups) *
Most common ball flight
Most common shot trajectory
Average carry distance in yards (6 iron)
Your answer
Average total distance in yards (driver)
Your answer
Average putts per round
Number of 3 Putts per round
Best part of your game? *
Common struggles *
Biggest frustration/most common miss?
Your answer
Do you know what is causing your miss? What are you doing to correct it?
Your answer
Ultimate goals in golf - why are you here? *
Your answer
What have you been doing to improve up to this point?
Your answer
What changes/improvements have you seen in your golf game? (if any)
Your answer
How much time can you allocate towards game improvement?
Your answer
Lifestyle Questions
Past/Current sports played (check all that apply)
Please list any health conditions (ex: High blood pressure, asthma, etc)
Your answer
Please list any physical injuries that you have had or pain you have experienced (ex: low back pain, torn ACL, etc.)
Your answer
How often do you exercise? *
What do you do for exercise?
Do you have any other fitness goals? *
Do you have a personal trainer? *
Is there anything else that we should know prior to your assessment?
Your answer
Have you had a chance to look at our program options? *
Agreement of Release and Waiver of Liability
By submitting this form I agree to the following:

1: That I am voluntarily participating in the Golf Fitness Classes, Training Programs, or
Workshops offered by S.M.A.R.T. Golf Fitness Instruction Inc, during which I will receive
information, recommendations, and instruction about health and fitness. I recognize
that golf fitness and personal training programs require physical exertion that may be
strenuous and may cause physical injury, and I am fully aware of the risks and hazards

2. I understand that it is my responsibility to consult with a physician prior to and regarding
my participation in the Golf Fitness Classes, Training Programs, or Workshops. I
represent and warrant that I am in good physical condition and I have no medical
condition that would prevent my full participation in any or all of the aforementioned
service offerings.

3. In consideration of being permitted to participate in any Golf Fitness Classes, Training
Programs, or Workshops, I agree to assume full responsibility for any risks, injuries, or
damages, known or unknown, which I might incur as a result of participating in the

4. In consideration of being permitted to participate in any Golf Fitness Classes, Training
Programs, or Workshops, I knowingly, voluntarily, and expressly waive any claim I may
have against S.M.A.R.T. Golf Fitness Instruction Inc., its owners, and/or employees, for
injury or damages, accidental or otherwise, that I may sustain as a result of participating
in the program.

5. I, my heirs, and/or legal representatives forever release, waive, discharge, and
covenant not to pursue legal action against S.M.A.R.T. Golf Fitness Instruction Inc, its
owners, and/or employees for any injury or death caused by their negligence or other

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. *
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