Physical Activity Readiness Questionnaire & Personal Training Service Agreement at KDT Academy

Thank you for your interest in our Personal Training Program at KDT Academy. This questionnaire is to help us match our services with your needs.

* Salutation

* First Name

* Last Name

* Birthday

* Mobile number:

* Email

* Emergency Contact Person:

* Contact person's mobile number

* Relationship to you:

What are your top 3 reasons for joining our fitness program?
Eg. Toning up: FizFit & Kettlebells, Working on technique: BJJ, Improving lifts: Kettlebells, etc.

	My reasons are:
1.
2.
3.

Health and medical disclosure

* Please mark YES or NO to the following:

	Yes	No
Has your doctor ever that you have a heart condition and recommended only medically supervised physical activity?
Do you frequently have pain in your chest when you perform physical activity?
Have you had chest pain when you were NOT doing physical activity?
Do you lose balance due to dizziness or you ever lose consciousness?
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program?
Are you pregnant now or have you given birth within the last 6 months?
Have you had a recent surgery?
Do you have any chronic illness or physical limitation (e.g. asthma, diabetes)?
Do you have any injuries or othopedic problems such as bursitis, bad knees, back, shoulder, wrist or neck?
Do you take any medication, prescription or non-prescription on a regular basis?
How does this medication affect your ability to exercise or achieve your fitness goals?

If you have marked YES to any of the above please describe here:

Lifestyle Related Questions

* Choose the best answer for each

* How often do you drink alcohol in a typical week?

I don't consume alcohol

1-3 glasses a week

4-8 glasses a week

9 glasses or more

* How many hours do you regularly sleep at night?

5 hours or less

6-9 hours

10 hours or more

* Describe your job

	Sedentary (drive to work, sit at a desk, long conference meetings)	Active (walking, moving about a lot on your feet)	Physically demanding (delivery, moving heavy items, construction)
How much physical activity is used in your regular work?

* On a scale of 1-10, how would you rate your STRESS levels?

List your top 3 biggest sources for stress:

	Sources of Stress:
1.
2.
3.

* Anyone in your family overweight?

Mother

Father

Sibling

Grandparent

* Were you overweight as a child?

	No	Yes & Age(s)
If YES at what age?

* Which day(s) would be ideal for your Personal Training Fitness sessions?

* What are the ideal times for your training sessions?

What do you feel will make it hard for you to attend classes or personal training sessions with us?

* Check the answer most applicable to you:

Your work schedule

Tired from a day of work or school

Knowing that it's going to be a hard Cardio session

Knowing that it's going to be a Strength training session

Traffic jams

Poor pre-workout meal choice

Missed meals during the day

Other

What do you feel will MOTIVATE you to attend classes or personal training sessions with us?

* Check the answers most applicable to you:

Consistent workout routine: predictable and you know what to expect

A different workout everytime: unpredictable and varied

Targeting specific weaknesses and addressing physical imbalances

Sometimes just having a chat about lifestyle and dietary choices, weight and fitness management topics

Challenging physical workouts everytime: Focused on strength, endurance and weight loss results

Moderate workouts everytime: Focused on current fitness and strength levels maintainance

Light workouts everytime: Nothing fancy, simple toning and just need to do some simple physical activity

Focusing on rehabilitation and combining with current physio/medically prescribed exercise

Other not listed here

Personal Training Session Agreement

* Service Agreement This agreement is in reference to our verbal agreement on the date of this form submission. My personal trainer and I plan to work together until I determine the service is not longer needed.

Responsibilities of the Trainer:

Once the personal trainer is notified, you will be contacted by the trainer within 48 hours.
Provide an initial health assessment for the client
Assist in determining realistic client goals and objectives.
Provide proper exercise technique
Record the progress of the client and provide necessary feedback
Evaluate and modify the program as necessary according to the changing needs of the client.
Will be required to inform the client in advance of any changes in meeting times and dates.
If the trainer is > 15 minutes late without the client’s approval, the trainer is considered a “no-show” and the remaining session is free (as decided by the client).

Responsibilities of the Client:

1. Timeliness

a. Failure to inform the trainer 48 hours in advance of a cancellation will result in loss of that training session.

b. The client must inform the trainer as far in advance as possible of any changes to time or schedule.

c. Client must notify the trainer is he/she wishes to discontinue personal training. The client has 48 hours after notification to have remaining sessions refunded.

d. The trainer is obligated to wait for the client up to 15 minutes and after that the client is considered a “no show” and will be charged for the session.

e. If the client is < 15 minutes late, the session will proceed using only the remaining time.

2. Abide by the rules and policies of the KDT Academy

3. Follow through on the recommendations of the initial health assessment.

4. Read and sign the Par-Q form, liability waiver, and medical & health history questionnaire.

5. Commitment to the program.

6. Adhere to advice concerning health and fitness activities outside of the time spent with the personal trainer.

- Obtaining most health and fitness goals require one to integrate current lifestyle with health objectives and goals.

- This usually requires dietary modifications as well as adherence to a set cardiovascular routine.

- These activities are performed mostly during the time spent outside the personal training sessions unless

otherwise requested.

7. Communicate with your trainer. It is crucial that the client keeps the trainer abreast of any discomforts, pain, or concerns.

8. Modifications to the program and schedule may be necessary. The fulfilling of the client’s needs is the purpose of our services.

9. The Personal Training sessions expire at the end of the package and each package has a 3 month validity, and any remaining session cannot be redeemed, replaced or exchanged for other goods or services after expiry.

10. Clients agree to CONTINUE the full payment at the agreed rate if they want to RETAIN THEIR CURRENT TIME & DAY SLOTS reservations when client is away on leave, failing which that particular time slot and day(s) will be made available to other clients without further notice.

I have read, understood and agree to the policies of KDT Academy Personal Training program as stated above

* Indicates Response Required

	No	Yes
Do you smoke?
Do you drink alcohol?
Does your job require travel?
Do you require nutrional advice and guidance?