Star Fitness - New Client Information
Personal Information:
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Email *
Your answer
What is your preferred method of contact? *
Birthday *
MM
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DD
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YYYY
Gender *
Marital Status?
Do you have any children?
Emergency Contact Information:
Name *
Your answer
Relationship *
Your answer
Phone *
Your answer
Email
Your answer
Fitness Background & Goals:
How did you hear about Star Fitness? *
What are your personal fitness goals? (Check all that apply) *
Required
On a scale of 1-10 (10 being the most), how serious are you in accomplishing your fitness goals? *
How often do you currently workout? *
What does your current exercise program consist of? *
Required
If you workout less than you would like, what are the reasons?
Health History:
Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity? *
Do you frequently have pains in your chest when you perform physical activity? Have you had chest pain when you were not doing physical activity? Do you lose your balance due to dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
Are you pregnant now or have given birth within the last 6 months? Have you had a recent surgery? *
Is your doctor currently prescribing any medication or supplements for your blood pressure or heart condition? *
Please explain any items you have marked YES:
Your answer
Do you have, or have you experienced, any of the following? *
Required
Please explain any checked items, including medications you may be taking for that condition:
Your answer
Do you have any other exercise restrictions we should know about?
Your answer
Star Fitness Informed Consent, Release, and Waiver of Liability and Indemnity:
I acknowledge that I have voluntarily chosen to participate in a program of intense physical exercise by a Star Fitness Trainer. I acknowledge that I have read and understand each of the statements below:

I understand this type of program can enhance the musculoskeletal and cardio respiratory systems. I also understand there are inherent risks in participating in a program of strenuous exercise. I have been informed of the possible strenuous nature of a personal/group training program and the potential for unusual , but possible, physiological results including , but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack or death. I agree that by participating in physical exercise or training activities, I do so entirely at your own risk.

I certify the answers to the questions outlined in the Health History form are true and complete to the best of my knowledge. I understand it is urged that I obtain physical examination from a doctor before using any exercise equipment or participating in any exercise activity. I understand medical clearance may be required based on the answers I gave on the Health History form. I understand and agree that it is my responsibility to inform my trainer of any conditions or changes in my health, now or ongoing, which might affect my ability to exercise safely and with minimal risk of injury.

I understand any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are my responsibility and I should consult a physician prior to undergoing any dietary or food supplement changes.

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 trainer. I give Star Fitness trainers and/or the staff of the facilities I train in, permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred.

I consent to the use of my name, quotes, and image in photographs, motion pictures or recordings during or in conjunction with camps/personal training for use in Star Fitness advertising, marketing or promotion.

I understand and agree that Star Fitness and Star Gymnastics, LLC is not responsible for any personal item or property that is lost, damaged or stolen during or in conjunction with the exercise program or on Star Fitness or Star Gymnastics, LLC premises.

I understand this waiver and release of liability includes, without limitations, all injuries which may occur as a result of; a) your use of all amenities and equipment at Star Gymnastics, LLC facility and your participation in any activity, class, program, personal training, supervision, or instruction, b) the sudden and unforeseen malfunctioning of any equipment c) our instruction, training, supervision, or dietary recommendations and d) your slipping and/or falling while at Star Fitness or Star Gymnastics, LLC on the premises, including adjacent sidewalks and parking areas.

BY TYPING YOUR FULL NAME IN THE BOX BELOW, YOU ARE DIGITALLY SIGNING THIS FORM AND CONSENTING TO THE WAIVER AND RELEASE DETAILED ABOVE.

Name *
Your answer
Date *
Your answer
Star Fitness Policies:
CLASS POLICY: Classes must have at least 5 participants to begin, and will be capped at 16. Please sign up for your class early to ensure your spot. For those who purchase a single class or an eight-class pass, please contact Brooke in advance so she can check the availability of the class you plan on attending. If you are not the first class of the day, please allow the previous class to exit before entering for your own class. Wear appropriate clothing and tennis shoes. Please do not wear shoes that are wet, muddy, or dirty. Anyone wanting to participate in a class must have a signed release.

GUEST POLICY: Friends or family members may attend their first class for free. If you have a guest that would like to participate in a class, arrive to class early enough to fill out the necessary paperwork.

REFERRAL POLICY: You will receive a $10 credit towards your next 8-week session for each friend or family member who joins an 8-week session due to your referral. They must mention your name when signing up.

PAYMENT POLICY: Payment is due before the first day of class. Cash, checks, or Venmo payments are accepted. Checks can be written out to Brooke Price; Venmo payments can be made to @brookeanne45. Sessions are non-refundable and non-transferable.

BY TYPING YOUR FULL NAME IN THE BOX BELOW, YOU ARE DIGITALLY SIGNING THIS FORM AND CONSENTING TO THE POLICIES DETAILED ABOVE.

Name *
Your answer
Date *
Your answer
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