Professional Documents
Culture Documents
Personal Information:
Name _____________________________
DOB___________________
Email______________________________
Phone
Number_________________
Gender_____________________
Height_____
Weight_____________
Occupation:________________________
Emergency contact person ______________________________
Emergency contact phone
number___________________________
Medical History:
Please place a Y for yes next to the statement if it applies to
you currently. Please place a * if it is a preexisting condition.
___________________
Neck
__________________________________________________________________
___________________
Knees
__________________________________________________________________
___________________
Shoulder
__________________________________________________________________
___________________
Feet
__________________________________________________________________
____________________
Hands Wrists
__________________________________________________________________
____________________
Elbows
__________________________________________________________________
___________________
Other injuries
__________________________________________________________________
___________________
Surgeries
__________________________________________________________________
___________________
Please describe any special considerations or how an injury may
affect your ability to function.
__________________________________________________________________
_____________________
Goals
1. What is your favorite sport, or leisure time activity?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
____________________________________________
2. Describe the most legendary version of yourself.
________________________________________________________
________________________________________________________
________________________________________________________
__
3. What are your goals?
________________________________________________________
________________________________________________________
________________________________________________________
__________________________________________
4. How will you commit to achieving these goals?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________
5. How long has it been since you have exercised
regularly?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
____
6. Do you have experience with free weight or functional
trainers?
________________________________________________________
____________________
7. What type of cardiovascular exercise are you unable to
perform?
________________________________________________________
____________________
8. Are there any exercises that are contraindicated or not
recommended by your physician?
________________________________________________________
____________________
9. How would you describe you level of daily activities?
________________________________________________________
____________________
Training Agreement
Informed Consent & Assumption of Risk
I ________________________________, am aware of my own health and
physical conditioning, and understand that my participation at
Maximum Performance Strength and Conditioning (S&C) facility may
cause injury. I am voluntarily choosing to participate in the program.
There are always certain risks associated with any physical activity. I
understand these risks and declare myself physically sound and
capable to participate in the program offered through the Maximum
Performance S&C center. The S&C Program is a program designed to
guide me, safely and effectively, through an appropriate individualized
program based on my initial fitness assessment and goal assessment.
Following the completion of a health history form and possibly a
doctors note and an initial consultation, I will be given an individual