Skip to content
Landing Page
Choose Life!
Main Menu
Landing Page
Membership Application
Membership Application
and
Liability Waiver
Start Date
Date of Birth
Name
Age
Email
Phone Number
Current Address
Sex
Male
Female
Height
Weight
Smoker
Alcohol
Do you have any health issues that I should be aware of? Please answer YES or NO. If yes, please explain.
Emergency Contact
Relationship
Phone Number
1. List the most important goal that you want to accomplish in this program.
2. Explain the āfuture complete youā (mind and body) that you envision in the future.
3. List the areas that you want to change, starting with the most important.
4. How much do you exercise, and how consistent would you like it to be?
Has a doctor ever said your blood pressure was too high? Yes. No. If yes, give date and explain.
Have you ever had pain in your chest or heart? Yes/No. If yes, give date and explain.
Do you often have difficulty breathing? Yes/No. If yes, give date and explain.
Has a doctor ever said that you have or had heart trouble, and abnormal ECG or EKG, heart attack or coronary? Yes/No. If yes, give date and explain.
Foot problems? Yes/No. If yes, give date and explain.
Are you pregnant or have you recently given birth? Yes/No. If yes, give date and explain.
Are you taking any prescription drugs or daily medications? How long? Yes/No. If yes, give date and explain.
Heart attack? Yes/No. If yes, give date and explain.
Arthritis of legs or arms? Yes/No. If yes, give date and explain.
Diabetes or abnormal blood-sugar tests. Yes/No. If yes, give date and explain.
Dizziness or fainting? Yes/No. If yes, give date and explain.
Epilepsy or seizures. Yes/No. If yes, give date and explain.
Stroke? Yes/No. If yes, give date and explain.
Anemia? Yes/No. If yes, give date and explain.
Asthma? Yes/No. If yes, give date and explain.
Injuries to legs, arms, neck, back or joints? Yes/No. If yes, give date and explain.
Broken bones or dislocations? Yes/No. If yes, give date and explain.
Cancer or leukemia? Yes/No. If yes, give date and explain.
Do you have regular health exams with a doctor? Yes/No. If yes, give date and explain.
Surgery? Yes/No. If yes, give date and explain.
The undersigned agrees to pay for Personal Fitness Training. Payments are due at the beginning of the month or before the start of the session. You may pay by cash or credit card via Zelle, Square, or by Life120 fitness app. ā¢ All Personal Training packages/sessions are non-refundable. ā¢ If the applicant cancels/does not show up for a training session, the applicant agrees to pay the session amount that is due for the cancelled session. Cancellations have to be made AT LEAST 24 hours before the start of the session, or the session will be forfeited. ā¢ The undersigned also understands that the allotted time for one session is one hour and will not hold the trainer responsible for lost time if the client does not show up on time. ā¢ The undersigned herewith assumes all risk of personal injury incident in the course of instruction of Personal Training/Exercise arising out of instruction undertaken by him/her. ā¢ The undersigned hereby acknowledges that personal contact is an integral part of the program and herewith consents that the trainer may make the necessary physical contact. The undersigned further agrees that he or she shall at no time maintain any claim of demand or institute suit against āLIFE 120 Fitness Programā and/or Freda Johnson, other trainers for personal injuries sustained as a result of the program. This instrument shall constitute a full and complete waiver for any claims for personal injuries arising out of the aforesaid instruction in consideration for the undersigned being accepted as a client for the aforesaid instruction, it is agreed that the applicantās rights may not be assigned to any. Applicant warrants, represents, and agrees that he/she is in good physical condition and that he/she has no disability, impairment, or ailing preventing him/her from engaging in active or passive exercise. I agree to abide by all of the rules and policies of the āLIFE 120 Fitness Programā as outlined in this agreement. I also agree that the LIFE 120 Fitness Program/Trainer reserves the right to cancel this agreement, for any means, before the ending date of this agreement.
I agree
Signed:
I am ready to start - Send!
membership application
Membership Application
And
liability WAiver
Start Date
Date of Birth
Name
Age
Email
Phone Number
Current Address
Sex
Male
Female
Height
Weight
Smoker
Alcohol
Do you have any health issues that I should be aware of? Please answer YES or NO. If yes, please explain.
Emergency Contact Name
Relationship
Phone Number
1. List the most important goal that you want to accomplish in this program.
2. Explain the āfuture complete youā (mind and body) that you envision in the future.
3. List the areas that you want to change, starting with the most important.
4. How much do you exercise, and how consistent would you like it to be?
Has a doctor ever said your blood pressure was too high? Yes. No. If yes, give date and explain.
Have you ever had pain in your chest or heart? Yes/No. If yes, give date and explain.
Do you often have difficulty breathing? Yes/No. If yes, give date and explain.
Has a doctor ever said that you have or had heart trouble, and abnormal ECG or EKG, heart attack or coronary? Yes/No. If yes, give date and explain.
Foot problems? Yes/No. If yes, give date and explain.
Are you pregnant or have you recently given birth? Yes/No. If yes, give date and explain.
Are you taking any prescription drugs or daily medications? How long? Yes/No. If yes, give date and explain.
Heart attack? Yes/No. If yes, give date and explain.
Arthritis of legs or arms? Yes/No. If yes, give date and explain.
Diabetes or abnormal blood-sugar tests. Yes/No. If yes, give date and explain.
Dizziness or fainting? Yes/No. If yes, give date and explain.
Epilepsy or seizures. Yes/No. If yes, give date and explain.
Stroke? Yes/No. If yes, give date and explain.
Anemia? Yes/No. If yes, give date and explain.
Asthma? Yes/No. If yes, give date and explain.
Injuries to legs, arms, neck, back or joints? Yes/No. If yes, give date and explain.
Broken bones or dislocations? Yes/No. If yes, give date and explain.
Cancer or leukemia? Yes/No. If yes, give date and explain.
Do you have regular health exams with a doctor? Yes/No. If yes, give date and explain.
Surgery? Yes/No. If yes, give date and explain.
The undersigned agrees to pay for Personal Fitness Training. Payments are due at the beginning of the month or before the start of the session. You may pay by cash or credit card via Zelle, Square, or by Life120 fitness app. ā¢ All Personal Training packages/sessions are non-refundable. ā¢ If the applicant cancels/does not show up for a training session, the applicant agrees to pay the session amount that is due for the cancelled session. Cancellations have to be made AT LEAST 24 hours before the start of the session, or the session will be forfeited. ā¢ The undersigned also understands that the allotted time for one session is one hour and will not hold the trainer responsible for lost time if the client does not show up on time. ā¢ The undersigned herewith assumes all risk of personal injury incident in the course of instruction of Personal Training/Exercise arising out of instruction undertaken by him/her. ā¢ The undersigned hereby acknowledges that personal contact is an integral part of the program and herewith consents that the trainer may make the necessary physical contact. The undersigned further agrees that he or she shall at no time maintain any claim of demand or institute suit against āLIFE 120 Fitness Programā and/or Freda Johnson, other trainers for personal injuries sustained as a result of the program. This instrument shall constitute a full and complete waiver for any claims for personal injuries arising out of the aforesaid instruction in consideration for the undersigned being accepted as a client for the aforesaid instruction, it is agreed that the applicantās rights may not be assigned to any. Applicant warrants, represents, and agrees that he/she is in good physical condition and that he/she has no disability, impairment, or ailing preventing him/her from engaging in active or passive exercise. I agree to abide by all of the rules and policies of the āLIFE 120 Fitness Programā as outlined in this agreement. I also agree that the LIFE 120 Fitness Program/Trainer reserves the right to cancel this agreement, for any means, before the ending date of this agreement.
I agree
I am ready to start - Send!