Online Registration

Please fill out this form in its entirety. Once submitted, your trainer will review this information and contact you within 48 hours.

First name*

Last name*

Sex*

D.O.B*

Height*

Weight*

Contact Information:

Email*

Mobile phone*

Medical Questions:

1. Has your doctor cleared you for exercising? If not, please get permission before starting the program.*

2. Do you have any pre-existing medical conditions that may interfere with exercising? (ex. High Blood Pressure)*

3. Have you had a serious injury in the past 3 years? Was surgery required?*

4. Are you on any medications? If Yes then which are those ?*

Exercise Questions:

1. How long have you been exercising? What did you normally do for exercise?*

2. What are your goals? Short Term and Long Term both ?*

3. When and how do you plan to achieve this goal?*

4. How many days a week can you exercise?*

5. How many minutes would you be able to dedicate?*

6. Would you be willing to do both cardio and weight training?*

7. How intense would you like your exercise program?*

8. What activities do you enjoy doing?*

9. What activities do you dislike doing?*

10. What time will you be exercising?*

11. Where will you be exercising? At home or at the gym? *

Lifestyle Questions:

1. What does your nutrition/diet look like?*

2. What would you consider to be your “bad habits”?*

3. What hobbies do you enjoy?*

4. Do you smoke? If so, how often/much?*

5. Do you drink alcohol? If so, how much/often?*

6. How many hours a night do you sleep?*

7. What is your daily routine like at work? Are you sitting in an office chair majority of the day or out and moving?*

**By submitting this form, you are voluntarily accepting the cautions of an exercise program. You recognize that the program requires physical exertion that may be strenuous at times and may cause physical injury and you are fully aware of the risks and hazards involved. You are stating you understand that it is your responsibility to consult with a physician prior to and regarding your participation in an exercise program. You represent and warrant that you have no medical condition that would prevent your participation in the program. You agree to assume full responsibility for any risks, injuries or damage known or unknown which you might occur as a result of participating in the program. I, the undersigned, do hereby consent and agree that Full Scale Fitness LLC., its employees, or contractors are not liable for any injuries or damage that may occur to me, property, or people around me during my exercise program or personal training. Results are not garaunteed.**

Fully read the paragraph above and electronically sign your name agreeing to the conditions and terms stated above.***

Name*

Date completed*

Comments/Questions/Concerns: