Bootcamp Assessment/Consent/Liability
Welcome to your fitness bootcamp. Please complete this assessment honestly and read through carefully. This is a group fitness class that is for all fitness levels! You will lose fat, strengthen, tone and feel great! We are a community of women that meet 2x/week for 45-60 minutes. Training consist of cardio, strength/core training, Tabata, stretching and meditation. 

"I was always leery about committing to an exercise program, but Nichole's class is on the first that I look forward to! She makes exercising fun with a great group of ladies. This bootcamp made me realize that it is important to take time for yourself to live a healthy lifestyle." ~Peggy
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Date:
Email Address:
Name (First and Last)
Age
Current Weight
Highest Weight
Goal Weight and Size
Have you ever worked with a Personal Trainer or Health Coach before?
Describe your health goals?
Describe your nutrition goals?
Describe your fitness goals?
Are you interested in a nutrition program to help with weight loss, muscle gain or weight maintenance?
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Do you currently follow any specific eating plan or lifestyle (vegetarian, Wegan, Low carb, Keto, Paleo, etc.?
What does a typical day look like for you? (ie. are you active, on your feet, sitting at a desk, etc.?)
Are you currently exercising regularly?
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If you are exercising, do you exercise at home or at a gym?
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How many days a week do you do cardiovascular exercise (walking, running, swimming, etc.)? And, how many minutes?
How many days a week do you do strengthening exercises (weight training, body weight, etc.)? And, how many minutes?
I do require you to exercise at least 2-3x/week on your non-bootcamp days. Are you willing to do this?
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Are you interested in a customized workout plan to help you reach you goal?
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How many hours a night on average do you sleep?
Is there any other information I should know about you?
How did you hear about boot camp?
Did you refer someone to bootcamp? If so, who?
PLEASE READ THE FOLLOWING AND CHECK YES IF YOU FEEL YOU ARE PHYSICALLY HEALTHY ENOUGH TO FOLLOW AN EXERCISE AND NUTRITION PROGRAM: For most people physical activity should not pose any problem or hazard. This is simply to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Please read carefully and check the yes or no opposite the question if it applies to you. Has your doctor ever said you have heart problems? Do you frequently have pains in your heart and chest or when performing physical activity? Do you often feel faint or have spells of severe dizziness? Has a doctor ever said your blood pressure is high? Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise? Is there a physical reason not mentioned here why you should not follow an activity program even if you wanted to? If you answered, YES to one or more questions, please consult your physician before engaging in physical activity. If you answered NO to all questions and answered this accurately, you have reasonable assurance of your present suitability for physical activity.
READ THE FOLLOWING FINE PRINT AND CLICK YES IF YOU AGREE: By returning this assessment to me you hereby certify that: ~ You are physically fit to start or continue a physical fitness regimen. ~ You understand that Nichole Barras (Healthy Bodies On The Go, LLC) is not a medical doctor, and will not give me medical device. You will seek competent medical advice before undertaking this physical training regimen. You will immediately stop exercising and seek medical attention if I suffer any pain, discomfort, lightheadedness, nausea, or numbness while exercising. ~You agree to abide by the terms and condition included with this Agreement. ~You hereby consent without further consideration or compensation to the use (full or in part) of all video, photographs, or other form of representation taken of you or submitted by you and/or recording made of my voice and/or written extraction, in whole or in part, of such recordings for the purposes of illustration, advertising, broadcast, or distribution in any manner for Nichole Barras (Healthy Bodies On The Go, LLC). ~RELEASE OF LIABILITY. You are enrolling in a regimen of moderate to strenuous physical activity. You affirm that YOU are in good physical condition and do not suffer from any disability that would prevent or limit your participation in this regimen. YOU ARE STRONGLY ADVISED TO CONSULT WITH A MEDICAL DOCTOR BEFORE ENGAGING IN THIS OR ANY OTHER PHYSICAL TRAINING PROGRAM. By participating in this program, YOU, release Nichole Barras (Healthy Bodies On The Go, LLC) and Oshner Lafayette General Medical Center from any and all liability now or in the future, including but not limited to resulting from your participation in this regimen however caused, regardless of any cause of action for loss of consortium that occurs as result of your participation in the regimen.
I HEREBY AGREE to an interview, an audiovisual recording, testimonials or to have photographs taken of me by a Nichole Barras for marketing purposes. If no restrictions, click (“none”)
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Bootcamp sessions will begin and end on time. Should you need to miss, please inform Nichole Barras. This is reserved for you. A $20 deposit is required prior to starting bootcamp. Please make payment to Venmo, @Nichole-Barras, check or cash. This holds your spot due to a maximum that is allowed. Remaining payment is due the day bootcamp begins. ALL PAYMENTS ARE FINAL. Please know there is medical circumstances and/or situation that are taken into consideration and based upon consideration. I agree to inform my coach/trainer if I will not be returning for appointments/sessions. By signing below, you adhere to this policy.
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