Personal Information

First Name

Last Name

Phone *

Email *

Date of birth

Occupation

How did you hear about us?

Goals & Expectations

What are your primary fitness goals? (e.g. weight loss, strength gain, mobility, injury rehab, etc.)

What is your timeline for achieving these goals?

Why are these goals important to you?

Have you worked with a personal trainer before?

Yes

What do you expect from me as your trainer?

How many days per week are you willing/able to train?

Exercise History

Are you currently exercising? If yes, what type and how often?

What types of physical activity or sports have you done in the past?

Do you enjoy any particular types of exercise?

What has worked well for you in the past?

What do you struggle with when it comes to exercise?

Health & Medical History

Do you have any current or past injuries? (if yes, please explain.)

Do you have any medical conditions? (e.g. heart disease, diabetes, asthma etc. If yes, please explain)

Are you currently taking any medications or supplements? (Please list)

Have you had any surgeries or hospitalizations? (If yes, please explain)

Do you have any joint pain, stiffness, or mobility limitations? (If yes, how does this effect your daily life?)

Are you pregnant or postpartum? (how many months?)

Do you experience any dizziness, fainting, or shortness of breath when exercising?

Do you smoke, or drink alcohol? if so, how much/how often?

Nutrition & Lifestyle

How would you rate your current eating habits? (scale or brief description)

Do you follow any specific dietary pattern or restrictions?

How would you rate your stress levels? (low/moderate/high)

Do you have any other lifestyle factors that may affect your training? (e.g. travel, shift work)

Motivation & Readiness

On a scale of 1-10, how motivated are you to reach your goals?

What obstacles do you anticipate in reaching your goals?

Do you have support from friends/family for your fitness journey?

What is your preferred method of accountability? (e.g. check-ins, tracking, challenges)

Consent & Agreements

Do you understand that all exercise involves risk and agree to participate at your own risk? *

Yes

Do you consent to receive coaching and recommendations based on your information? *

Yes

Do you give permission to use your progress photos (if applicable) for marketing? (optional) *

Yes

Liability & Release Waver

I understand that participation in personal training involves strenuous physical activity and may carry the risk of injury. I voluntarily assume full responsibility for any risks, injuries, or damages I may incur as a result of participating in training activities.

I affirm that I am in good physical condition and have no medical issues that would prevent safe participation. I have consulted with a physician or assume full responsibility for participating without medical approval.

I hereby release, waive, discharge, and hold harmless Elite Mom Athletics, LLC, its employees, contractors, and affiliates including Glory Stauss from any and all liability, claims, or demands for injuries or damages resulting from my participation in personal training, whether caused by negligence or otherwise.

I agree to indemnify and hold harmless Elite Mom Athletics, LLC and Glory Stauss from any loss, liability, or cost, including legal fees, arising from any claims related to my participation.

I have read this waiver, understand its contents, and sign it voluntarily. I understand that by signing, I am waiving certain legal rights.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Signature liability & release form

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