2025 Bootcamp Sign Up and Waiver - NW Personal Training

Please complete and return to NW Personal Training at least 2 days prior to your first scheduled workout.

All information received on this form will be treated as strictly confidential. Please fill out the form completely and accurately.

Name(Required)

Required

Age

Date of Birth

Address(Required)

Required

City(Required)

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State(Required)

Required

Zip Code(Required)

Required

Phone

Email(Required)

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Occupation

Emergency Contact

Relationship

Emergency Contact Phone Number

PAR-Q FORM

Please Mark YES or No to the following:

Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?

Yes

Do you frequently have pains in your chest when you perform physical activity?

Yes

Have you had chest pain when you were not doing physical activity?

Yes

Do you lose your balance due to dizziness or do you ever lose consciousness?

Yes

Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)?

Yes

Are you pregnant now or have given birth within the last 6 months?

Yes

Have you had a recent surgery?

Yes

If you have marked YES to any of the above, please elaborate below:

Do you take medications, either prescription or non-prescription, on a regular basis?

Yes

What is the medication for?

How does this medication affect your ability to exercise or achieve your fitness goals?

Fitness History

Have you been exercising consistently for the past 3 months?

Yes

On a scale of 1-10, how would you rate your present fitness level (1=Worst 10=Best)?

Please enter a number less than or equal to 10.

Tell us how we found you and help us inspire others!:

How did you hear about us? Please check all that apply.

Word of Mouth Referral? - Who? We want to thank them!

For reminders and schedule changes would you like Email, Text or Both?

Text

Both

Participant Release and Knowledge of Agreement

I have read this Release and Terms of Agreement and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance.

Client Signature(Required)

By typing your name in this box, you are agreeing to this participant waiver, release and knowledge of agreement

Date

Guardian's Signature

Required for clients 17 years old and younger

Date

CAPTCHA

This field is for validation purposes and should be left unchanged.

2025 Bootcamp Signup and Waiver (1)

PAR-Q FORM

Please Mark YES or No to the following:

Tell us how we found you and help us inspire others!: