MomTrainer.com BYOBaby Waiver and Release form
Hello!

First of all, THANK YOU for setting aside some YOU time and for reaching out! I'm so excited to work with you on your Fitness goals and get you RESULTS!

The purpose of this form is to help me design our workouts. Please email me with any additional information or questions you may have.
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Let's get to know each other, what's your name? *
What's your email? *
Would you like to be added to the MomTrainer Newsletter? (Monthly nutrition, fitness, and health tips plus NO spam.) *
Required
The best number to reach you? *
My cell is 978-505-9465. Please call me if you need help finding us.
Emergency Contact Info- Name and Number *
Now- where are you at, Momma? *
How many weeks/ Pregnant months/ years postpartum are you?
Has your physician cleared you for physical activity? *
Any complications during delivery that I need to be aware of? *
Do you experience chest pain, cramping in your calves, extreme dizziness, heart palpitations, fainting, or tingling when you exercise? *
If you answered yes to the previous questions for any reason, please share some details: *
Have you been checked for diastasis recti and/or pelvic organ prolapse? *
Any low back/ pelvic pain? *
If you have been diagnosed with prolapse or have a diastasis larger than 1cm, please elaborate below: *
Do you ever experience pain or discomfort during sex, a feeling of pressure or discomfort in your vaginal area during exercise, urinary incontinence of any kind, or the feeling that something's not quite right "down there"? These are symptoms of Pelvic Organ Prolapse that I will need to be aware of before I can recommend any exercise routine. Please elaborate with all you are comfortable with, (and know that everything we discuss is 100% confidential). *
Please list any medications you may be taking: *
Do you have any injuries or medical complications I need to be aware of?
Please list with detail!
What goals would you like to work on together?
Select as many as you like
Any specific workout preferences? Muscle groups you want to work on?
ie more cardio, more of a specific muscle group
Okay - let's get to the nitty gritty- what questions do you have for me?
Please list them out along with any details.
Some safety stuff:
Class will be cancelled due to poor weather or unsafe situations at our discretion. I keep no guns or weapons in my home and there are no drugs/ edibles accessible as well. Please bring any snacks/ toys/ diapers etc that your chid might need and are okay sharing. You are responsible for your own child.
Please Initial and Date below: *
Waiver and Release: I agree that with the many health benefits of exercise there is a risk of injury and in the rarest of instances, death. I, (the client) agree that by engaging in any physical activity under the guidance or instruction of my trainer, Sarah Ann Corkum, I do so at my own risk. I agree that I am voluntarily participating in activities and assume all risk of injury or illness. I agree to release and discharge Sarah Ann Corkum from any and all claims or causes of action (known or unknown) arising out her negligence. I acknowledge that I have carefully read and fully understand that it is a release of liability. I hear-by waive any right that I may have to bring a legal action to assert a negligence claim. I have read this entire document and have answered all of the questions to the best of my knowledge. __________________________
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