Pre-Training Questionnaire

Please take a few minutes to carefully fill out this health form and click "submit" at the bottom of the page. For your privacy, the information you provide in response to these questions is strictly confidential. Thank you!

My Basic Information

First Name *

Last Name *

Birthday *

Address 1 *

Address 2

City

Zip / Post Code

Country

Email *

Cell Phone

Work Phone

Occupation

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

My Health, Fitness and Physique Goals

What parts of your body are you unhappy with?

What days of the week and times are you available to meet for training?

How many hours a week do you spend on your health/physique? (Consider time spent going to the gym, classes, hiking, reading articles, etc.)

If you are training for a sport or event, please share what they are:

What are you looking for in a trainer?

My Fitness

If yes, please explain the injury and treatment:

If yes, please explain:

If yes, please tell list your medication and corresponding health issue.

If you answered yes to either question, how many cigarettes on average did/do you smoke?

If yes, what trimester? If no, have you ever been pregnant?

If yes, please list any concerns you might have:

Accuracy of Information Provided

I hereby acknowledge that the information I have provided in this health questionnaire and release form is truthful and correct, and that I have no medical conditions that should prevent me from exercise against the advice of any of my doctors or medical professionals.

Signature (type full name) *

Date

Confirm Birth Date *

Parent/Guardian Consent

Acknowledgement and Consent: I understand that President Productions/President Training Systems/DAE/ENL Fitness uses local recreational facilities and understand that all centers are operated by separate governing bodies. From time to time, the use of these facilities will have to be changed to accommodate their programs. The upkeep and maintenance of these facilities are beyond the control of President Productions/President Training Systems. However, we will address any unsafe conditions and make the operators aware of this, we will not utilize any courts that are unsafe. President Productions will be authorized to utilize any photographs or videos of my child that may be taken during involvement in their training activities. I consent to such uses and hereby waive any rights of compensation.

Waiver of Liability & Disclaimer: In consideration of my child’s membership, and any participation in the activities and special programs or events of President Productions/President Training Systems/DAE/ENL Fitness on behalf of myself and my child and any heirs or assigns of myself or my child, waive, release, and agree to defend and hold harmlessPresident Productions/President Training Systems/DAE/ENL Fitness, and its sponsors, staff members, board of directors, and any other affiliated persons and/or vehicle drivers from any and all claims, injuries, death, damages, and demands arising or in any way resulting from or connected to any training-related event, activity, program, or property. I attest and verify that I have full knowledge of the risks involved in basketball training-related events, activities, programs, and properties and that I will, on behalf of the my child, assume and pay any medical or emergency expenses. I further acknowledge that my child is physically fit to participate in the programs or other activities of President Productions/President Training Systems.

Emergency Authorization: I, the undersigned, as parent/guardian of my child, hereby authorize the staff of President Productions/President Training Systems/DAE/ENL Fitness, its sponsors, and vehicle drivers as my agents to consent to medical, surgical, dental examination or treatment of my child. In case of emergency, I hereby authorize treatment or care at any hospital or by any licensed medical personnel.

NOTE: YOUR SIGNATURE BELOW ACKNOWLEDGES THAT YOU HAVE READ AND ACCEPT THE POLICIES/CONDITIONS OF PRESIDENT PRODUCTIONS/PRESIDENT TRAINING SYSTEMS AS DESCRIBED ABOVE.

Parent/Guardian’s Signature (type full name)

Date