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Registration

Please pop your details in below to register with Streamline PT for personal training support. 

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Your details are protected under my privacy policy, and required to help me to best support you. 

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Please read the terms below and then complete both forms. By signing you are agreeing to these terms. 

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Eligibility
Clients will be required to complete the proper documentation prior to participation within the personal training programme.
The Personal Trainer reserves the right to deny services to participants who may not be able to exercise safely within the programme parameters.

Conduct of Training Sessions
Clients must wear proper attire.
All sessions will be conducted at the facility agreed upon by the Personal Trainer and Client.

Cancellation
Cancellation must be made at least 24 hours in advance of the confined session start time. Once a session is cancelled every effort will be made to reschedule the training session according to the mutual availability of the client and trainer.

*If cancellation is not made a minimum of 24 hours prior to the scheduled session, the client understands that he/she will be charged 50% of the agreed session price.100% of the agreed session price will be charged in the event of 12 hours or less notice been given likewise a ‘no show’ will be charged in the same way.
 

Part 1 - Your Information

Gender
Male
Female
Prefer not to say
Other
Date of Birth

Part 1 - Medical Clearance Form

Are you suffering from a heart Condition (heart attack, angina, irregular beat, hole in heart etc) ?
Do you feel pain in the chest when performing physical activity?
Do you suffer from high or low Blood Pressure?
Are you taking medication to control your blood pressure or a heart condition?
Do you have a back or joint problem that could be made worse through physical activity?
Do you knowingly suffer from Diabetes?
Do you suffer from respiratory Illness (asthma, bronchitis, emphysema) or have shortness of breath with mild exertion?
Have you ever fainted or become dizziness through light exercise?
Are you under medical treatment for any illness?
Have you had a serious injury or operation within last 18 months?
Do you smoke? If yes please indicate how many a day.
For Ladies Only – Are you pregnant (or have you had a child in the last 3 months)?

Part 3 - Exercise History & Interests

For each activity below, can you indicate how many minutes you would typically engage in that exercise.

By submitting this form you 'sign' to declare that the above details are correct to the best of your knowledge.  You agree to notify me, as your personal trainer, of any changes to my medical condition. Streamline Personal Training will not be held responsible in any way, for any harm or injury to individuals who ignore any given instruction. 

This questionnaire will help me to understand your personal fitness goals.


Please indicate your personal health and fitness-related goals:

Lose Weight
Yes
No
Feel Better
Yes
No
Improve Flexibility
Yes
No
Lower My Cholesterol
Yes
No
Reduce Back Pain
Yes
No
Aerobic Fitness
Yes
No
Stop Smoking
Yes
No
Look Better
Yes
No
Injury Rehab
Yes
No
Sport Specific
Yes
No
Muscular Strength
Yes
No
Muscular Size
Yes
No
Reduce Stress
Yes
No
Improve Diet
Yes
No
What is your motivation level?
High
Medium
Low
What is your confidence level?
High
Medium
Low
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