|
Waiver/Release |
Sharp Performance
131 S. Santa Fe
Salina, Ks 67401
Email: info@sharpks.com
Phone: (785) 404-1544 |
I hereby agree to participate and/or engage in the programs offered Sharp Performance hereafter referred to as SP upon the understanding and agreement that:
1. I am aware of the risks of illness or injury inherent in any sport and exercise, program or attendance of such event. These injury risks include, but are not limited to: being hit by balls, bats, flags, lightning, stepping or tripping in holes or other indentations of the facilities surface; injury from insects, animals, birds or snakes; pulled muscles or other sprains, strains, dislocations, separations, broken or fractured bones, heart attack, stroke, cardiac complications, cerebral or spinal injuries. I am participating in the SP’s programs upon the express understanding that I hereby indemnify, waive and release SP, its employees, agents, officers, Directors, Successors and Assigns from any and all claims, costs, liabilities, expenses or judgments, including attorney’s fees and court costs (hereafter referred to as the “claims”) arising out of my participation or attendance in the programs(s) or any illness or injury resulting there from, and herby agree to indemnify and hold harmless SP from and against any and all such claims.
2. The coaches and employees of SP are not held responsible or liable for injuries or illness incurred while participating in any activity or event held by SP.
3. Acknowledging the desirability of a physical examination before participation, I represent to SP that I am physically capable of participation in the program of my choice without injury. I warrant and represent to you that I have no disability, impairment or ailment preventing me from engaging or participating in activity that will be detrimental or injurious to my health, safety, or physical condition if I do so engage or participate.
4. I agree to a photo and testimonial release; meaning my picture may be taken and used for marketing purpose of SP and their partners.
5. I assume full responsibility for myself and anyone who participates in an SP event or activity under this waiver, including any children/dependents, or any guests, and shall indemnify management, its affiliates, agents and employees against any and all liability incurred by them toward such. I understand and agree that any person or party to my waiver will also be a party to this waiver/release. I hereby execute and deliver this waiver and release so that I or my listed participants may participate in the programs offered by SP.
6. I authorize the use of medical personal, and also the use of EMS to transport to local hospital to administer treatment to any injury or illness incurred while participating in or at an SP event or activity.
I the participant agree to the above terms of the Waiver/Release. Either for my personal self, child, dependent or party listed below.
IF The PARTICIPANT IS 18 OR OLDER
Printed Full Name
Signature
Date
IF PARTICIPANT IS LESS THAN 18 YEARS OF AGE:
Printed Full Name of Participant:
Printed Full Name of Parent/Guardian:
Signature
Date
Welcome to Sharp Performance!
Participant/s Information
If registering more than one child and additional child information is different from above, please list information below.
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
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Low/Not Important |
High/Important |
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1 2 3 4 5 |
Your present athletic ability |
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Your present cardiovascular capacity |
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Your present muscular capacity |
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Your present flexibility |
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When you exercise, how important is competition? |
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5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
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b. Lose weight/body fat |
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c. Reshape or tone my body |
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d. Improve performance for a specific sport |
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e. Improve mood and decrease stress |
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f. Improve flexibility |
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g. Increase strength |
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h. Increase energy level |
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i. Feel better |
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j. Enjoyment |
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15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
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WHAT ARE MY TRAINER’S RESPONSIBILITIES?
1. A Sharp Performance Trainer provides clients with education, guidance, and the individual instruction required to achieve their personal fitness goals.
2. The trainer will design a safe, effective exercise program on an individual basis that reflects the client’s objectives, fitness level, and experience.
3. If the trainer is late for a session, that time is owed to the client at no additional charge.
4. Once you have purchased your initial training package from the Sharp Performance Director, your trainer will contact you within the next 3 days either by phone or email to set-up your training schedule.
5. The trainer will maintain an open line of communication throughout the course of service.
6. If there is a problem with a trainer’s customer service, the client should contact the Sharp Performance Supervisor at 785-643-3664 or Jake@sharpks.com.
WHAT ARE MY RESPONSIBILITIES?
1. All training fees are paid at the time of agreement. No trainings will take place until sessions are pre-paid. Sessions can be purchased all at once or dues can be deducted at the first of every month from the clients account.
2. Complete all forms in the packet provided or complete them online at sharp-performance.com and turn them into your trainer. Failure to do so may result in delayed initial consultation. These completed forms will be used in establishing your baseline and are kept entirely confidential, along with any personal information you share with your trainer during sessions.
3. Be on time for meetings with your personal trainer. The time of sessions will be agreed upon between the trainer and the client.
4. If the client is late, the session will only last until the end of the session that was scheduled.
5. Any tardiness of more than ten minutes or absence without proper notification will result in the loss of the session.
6. If a session needs to be rescheduled for any reason other than an emergency, a 24-hour prior notice must be given directly to your trainer. Failure to do so will result in the client forfeiting the session and no payment reimbursement will be granted.
7. Clients are allowed to reschedule one session per month with 24-hour prior notice given to their trainer. Otherwise, the trainer is not responsible for missed sessions. No rollover sessions or refunds will be granted, except for medical reasons, which must be confirmed by your physician.
8. It is recommended that you bring a water bottle (NO GLASS BOTTLES) to every session.
9. If you have any questions feel free to contact the Sharp Performance Supervisor (785)-643-3664.
I have read the trainer and client responsibilities as listed above.
I understand that I will not be permitted to continue training with a Sharp Performance Trainer if payment is not made as contracted above and Sharp Performance LLC reserves the right to cancel any and all training sessions if I breach this contract in any way.
I agree that I will be responsible for all collection cost, court costs and attorney fees associated with the collection of any past due fees owned to Sharp Performance LLC
CANCELLATION POLICY
I acknowledge that appointment times are reserved and that cancellation must be made at least 24 hours in advance. Cancellations should be made by calling my trainer directly.
I understand that all sessions must be used by the end of the agreed upon training period or they will be forfeited. It is my responsibility to attend my training appointments when they are scheduled.
I understand Sharp Performance LLC has the right and authority to terminate the program with no refunds should I breach this agreement.
Signing this agreement confirms that the client has been provided with a copy of Sharp Performance policies; that both CLIENT and TRAINER understand their roles and responsibilities; and that both client and trainer will do their part to ensure the best results for the goals set.
This agreement must be signed prior to beginning the training sessions.
Client's Signature:
Date: