Forms

WillTrainU Cancellation Policy

Name *

First

Last

Email *

Personal trainer must be notified of any cancellations 24 hours in advance of scheduled sessions. You must receive confirmation of cancellation from the trainer. If you do not appear for a scheduled appointment or fail to give 24 hours notice, you will be charged for the full session. Please contact personal trainer if you are going to be more than 5 minutes late for a session. Personal trainer will only wait 15 minutes for late arrivals and your sessions will start from the time agreed upon. *

I CONSENT

WillTrainU Intake Questionnaire

Name *

First

Last

Email *

Phone Number

Date of Birth

Please check any relevant HEALTH CONDITIONS

Dizzy Spells
Heart Problems
Arthritis
Autoimmune Conditions (ex. Lupus, Crohn’s disease)
Rhabdomyolysis
Orthopedic Surgery (ex. ACL repair, knee replacement)
CODP / Asthma
Neurological Conditions (ex. prior stroke, paralysis, Parkinson’s)
Currently Pregnant?

Please explain any medical conditions you may have.

Please list all medications and supplements you take.

How many days a week do you currently workout?

Do you have any experience using barbells?

If you currently exercise, please describe what your routine looks like.

What type of gym access do you have?

None
Gym Membership
Apartment Gym
Home Gym
Group Classes

What types of equipment do you have access to?

Weight Machines
Dumbbells
Apartment Gym
Barbells
Cardio Equipment

Is there anything in particular that has you seeking a personal trainer at this time? Health concerns? Upcoming life event?

What are you hoping to achieve through hiring a personal trainer? What are you specific goals (i.e. weight loss / better athletic performance / more muscle / just feeling better / improving chronic pain)? Please describe in detail:

Do you follow a structured meal plan? (meal prep service, Weight Watchers, etc.)

Do you eat at regular meal times?

Do you have any dietary restrictions (vegan, vegetarian, food allergies or sensitivities)?

Do you track your food?

Do you frequently travel for work, have an unpredictable work schedule, or do shift work? Please describe.

Do you drink alcohol?

If you drink alcohol, how many drinks do you average a week?

Does the nature of your job or lifestyle involve frequently eating out and/or consuming alcohol?

Do you do any illicit drugs? Please list.

How did you hear about me?

Friends
Social Media
Google
Other

WillTrainU WAIVER AND RELEASE OF LIABILITY

Name *

First

Last

Email *

Date of Birth

Have you been hospitalized in the last 12 months? *

Are you suffering from a medical condition, illness, or injury? *

If you answered yes to any question, please elaborate *

IN CONSIDERATION OF the risk of injury that exists while participating in PERSONAL TRAINING (hereinafter the "Activity"); and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same; I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge Vaibhav Maurya, M.D of FITMD LLC and William Couch of WillTrainU, located at 391 9th St NE, Atlanta, Georgia 30309, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releasees"), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity. *

ACKNOWLEDGE

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY. *

ACKNOWLEDGE

I FURTHER AGREE to indemnify, defend and hold harmless the Releases against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs. *

ACKNOWLEDGE

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Releases. In the event that I should require medical care or treatment, I authorize Vaibhav Maurya, M.D of FitMD LLC and William Couch of WillTrainU to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. *

ACKNOWLEDGE

I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the Activity unless I am medically able and properly trained, and I agree to abide by the decision of the WillTrainU official or agent, regarding my approval to participate in the Activity. *

ACKNOWLEDGE

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Vaibhav Maurya, M.D of FitMD LLC AND WILLIAM COUCH OF WILLTRAINU AS WELL AS ALL OF THEIR AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, VOLUNTEERS, STAFF, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FitMD LLC OR WILLIAM COUCH FOR PERSONAL INJURY OR PROPERTY DAMAGE. *

ACKNOWLEDGE

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of FitMD LLC and William Couch of William Couch, their agents, and employees. *

ACKNOWLEDGE

I agree that this Release shall be governed for all purposes by Georgia law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements. *

ACKNOWLEDGE

In the event that any damage to equipment or facilities occurs as a result of my or my family's or my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. *

ACKNOWLEDGE

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION. *

ACKNOWLEDGE

Initials *

Checkboxes *

I declare that the info I’ve provided is accurate & complete

Forms

WillTrainU Cancellation Policy

WillTrainU Intake Questionnaire

WillTrainU WAIVER AND RELEASE OF LIABILITY

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