Client Release Form


Policies

 

  1. In addition to this form, Client will be required to sign and return the following forms to EVOLT prior to receiving a Fitness Consultation, Training Program Design, or beginning any Personal Training program:
    • a. Waiver, Release, and Assumption of Risk Form
    • b. Waiver, Release, and Assumption of Risk (Home Workouts), if applicable
    • c. Physical Activity Readiness Questionnaire (PAR-Q)
    • d. Health History Questionnaire
    • e. Valid up to date health insurance
  2. If you have any of the following physical conditions, you may be required to have a Medical Clearance and Physician’s Consent Form:
    • a. Hypertension (>145/95 mm Hg)
    • b. Hyperlipidemia (cholesterol >220 mg/dl or a total cholesterol-to-HDL ratio of >5.0)
    • c. Diabetes
    • d. Family history of heart disease prior to age 60
    • e. Smoking
    • f. Abnormal resting EKG
    • g. Any other condition that AgonaFit in its sole discretion may deem to present an unreasonable risk to your health, were you to participate in a fitness evaluation or program.
  3. Unless other arrangements are made, Personal Training sessions, and Program Design explanations (these services herein individually and collectively referred to as “sessions”) last approximately 45, 60 or 90 minutes depending on the length of the session purchased. In order to provide the best service to all Clients, EVOLT cannot commit to extending any particular session beyond its previously scheduled time. In those cases where schedules do permit, Clients may request to extend sessions beyond sixty minutes at the current hourly session rate. Note that some sessions may be less in time due to the level of fitness that a client may have and or the intensity level is to great to keep up for a prolonged time. This time cannot be added to other sessions in the future.
  4. Rates for EVOLT services are subject to change. Services prepaid for by Client, which are unused at the time of any rate change, will be honored at the price already paid. Sessions are good for two (2) months from purchase date. Unless noted by injury, maternity leave or family emergency. If not understood please refer to an EVOLT employee who will advise unique circumstances.
  5. Time slots are available on a “first-come, first-served, time frame discussed” basis by appointment. Sessions, whether purchased a la carte or as part of a package, must be paid for when the appointment is booked. Client may schedule prepaid sessions in advance.
  6. In order to provide the best possible service to all Clients, EVOLT asks that all Clients be ready to begin their session at the scheduled time. Time lost at the beginning of a session due to a Client’s tardiness cannot be made up at the end of the session, as that could potentially impact the next scheduled Client. Unless prior arrangements have been made, a Client will be deemed a “no-show” when they are not present at time of session start time (unless note to trainer is sent stating they are coming). No refunds or credits will be given for “no-shows”.
  7. Regarding cancellations:
    • a. All qualifying cancellations will result in a credit being given which can be applied to a future session or other product or service from EVOLT.
    • b. All cancellations must be made with a MINIMUM of 24 hours advance notice in order to receive credit for the session. Due to an inability to fill the previously blocked time period, cancellations with less than 24 hours notice given will not qualify for a credit and Client will be charged for the session. All cancellations must be made by calling phone number “612-963-7609” to be deemed effective. If there is no answer Client must leave a message. An unresponsive text will not be valid as proper cancellation. I.E. of 24 hours means that an effective cancellation phone call at 4pm Friday for a 5pm Saturday. If a phone call/message is received at 6pm Friday for a session at 5pm Saturday that is deemed a “no show” and Client will be charged for that session.
    • c. If Client receives credit for a missed session, the credit must be used within 60 days of the missed session, or it will be waived.
    • d. If EVOLT needs to cancel a scheduled session, Client will receive credit for such session.
    • e. EVOLT works on office hours as normal places of operations do. The office hours are from 6am 6pm. Monday through Friday. And on Saturday from 7am – 2pm. Sunday is closed and will not be responded to. MONDAY WORKOUTS NEED TO BE CANCELLED ON SATURDAY! Anything outside of this time frame will not be responded to. If it is an emergency please call and leave a message. TEXTs are not used in emergencies and are not a good from of communication.
  8. Payment is due at the time the appointment for a session is booked. EVOLT accepts cash, or Zelle quick pay. If one is to use a CC it will be charged an additional 3% to the total payment.
  9. Clients are required to observe any and all rules of the gym or facility where workouts take place, if applicable.
  10. Shirts and shoes are required at all times during sessions. Client should also have water available as necessary during the workout. (See Client expectations) Also noted if you smell very badly I will ask you to go and get another shirt or clothes as you can bother other clients. (Don’t be that guy, Wash your clothes after you workout)
  11. Clients have the right to terminate a particular exercise or workout at any time. You are in control of your workouts! If an exercise is uncomfortable or painful, or if you want to stop for any reason, you may do so. If a particular exercise is painful for you to do or you have an injury or other limitation that makes it difficult for you to do, EVOLT can attempt to substitute another exercise to work that particular effect.
  12. You will get from your workouts what you put in. Results will vary by individual and EVOLT cannot guarantee specific results. Client acknowledges that Client is responsible for their decisions regarding whether or not to exercise consistently, eat properly, rest enough, and live a healthy lifestyle.
  13. EVOLT respects your privacy. Due to the nature of our services, it is necessary to collect certain personal information from Clients. All information collected is treated as STRICTLY CONFIDENTIAL, and EVOLT will not share or redistribute your information with any third party except as necessary to provide services purchased by the Client, or as required by law. Any information gathered from a Client is simply for our records and, if applicable, necessary to provide the services to the Client for which we have been contracted.
  14. All Terms and Conditions are subject to change. The most current version of these Terms, Conditions, and Policies will be posted on (Currently in Development)

 

Health and Medical History

 

December 12, 2019

Emergency contact:

Physical activity should not pose any problem or hazard to the majority of people. The following questions are designed to identify the small number of adults for whom physical activity might be inappropriate or those who should seek medical advice prior to initiating a fitness program or other change in their physical activity levels.

Are you over age 55 and/or not accustomed to vigorous exercise?

Have you ever been diagnosed with Type I or Type II Diabetes?

Do you have any reason to suspect that you might now pregnant, or have you been pregnant within the last 3 months?

Have you had any major or minor surgery in the past 3 months?

Have you been hospitalized in the last 2 years?

Are you currently, or have you in the past, ever seen a chiropractor or physical therapist for any condition?

Do you ever experience unexpected shortness of breath, or labored breathing, with or without pain?

Do you currently, or have you ever, experienced unexplained heart palpitations or been diagnosed with a heart murmur or irregular heartbeat?

Have you ever been diagnosed with high blood pressure?

Do you know what your blood pressure normally is?

Do you currently smoke?

Did you ever smoke?

Is there any history of heart disease (prior to age 55) in your immediate family?

Do you know your cholesterol levels? Do you know your cholesterol levels?

Do you receive regular annual physical exams from your primary care physician?

 

I,  , certify that I understand the foregoing questions and my answers are true and complete. I also understand that if this information changes in any way in the future, it is my responsibility to notify my personal trainer, and that I assume the risk for any changes in my medical condition that might affect my ability to exercise.

Before beginning a new fitness program or other significant change in your physical activity levels, you are advised to consult with your physician or primary health care provider. Only a physician or qualified health care provider is able to diagnose and prescribe treatment for specific health conditions.

I acknowledge that I have read the foregoing statements and fully understand the content thereof, and that if I choose not to consult with my physician or primary health care provider, I do so at my own risk.

 

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 and Older

 

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. (Some are also being lazier than ever too.) Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the question carefully and answer each one honestly by checking Yes or No.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Do you feel pain in your chest when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity?

 

If you answered yes to one or more questions

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

  • Start becoming much more physically active. Begin slowly and build up gradually. This is the safest and easiest way to go.
  • Take part in a fitness appraisal. This is an excellent way to determine you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as cold or a fever – wait until you feel better; or if you are or may be pregnant – talk to your doctor before you start becoming more active.

Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change you physical activity plan.

Informed Use of the PAR-Q.

EVOLT Training assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity. I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

 

Release of Liability

 

1. In consideration of being allowed to participate in a fitness assessment and personal fitness program provided by NATE VORONYAK (EVOLT Training) and to use his facilities, equipment and services, in addition to the payment of any fee or charge, I do hereby forever waive, release and discharge EVOLT Training and agents, employees, representatives, executors and all others acting on his behalf from any and all claims or liabilities for injuries or damages to my person and/or property, including those caused by the negligent act or omission of any of those mentioned or others acting on his behalf, arising out of or connected with my participation in any activities, programs or services of Trainer or the use of any equipment provided and/or recommended by Trainer.

Initials: 

 

2. I have been informed of, understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury regardless of severity or death.

Initials: 

 

3. I do hereby further declare myself to be over the age of eighteen as of the date of signing this document, physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in these activities, whether or not the activities require the use of any equipment. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the fitness program. I acknowledge that either I have had a physical examination and have been given my physician’s permission to participate or I have decided to participate in the exercise activities, programs and use of equipment without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs and use of equipment.

Initials: 

 

4. I understand that all information and services provided by (EVOLT is of a general nature and is provided for educational purposes only. None of the information or services provided by Trainer is to be taken as medical or other health advice pertaining to any specific health or medical condition that I may have or have had. The information and services provided by Trainer is not a diagnosis, treatment plan, or recommendation for a particular course of action regarding my health and is not intended to provide specific medical advice.

Initials:

 

Waiver, Release, and Assumption of Risk Form

 

I, , have volunteered to participate in a fitness program provided to me by  (EVOLT) which may include, but may not be limited to, resistance training and aerobic or cardiovascular exercise. In consideration of Trainer’s agreement to instruct and train me, I do here now and forever release and discharge and hereby hold harmless Trainer and his respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from.

THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO TRAINER OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.

I, , have been informed of, understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death.

I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I, , have chosen not to obtain a physician’s consent prior to beginning this fitness program with Trainer, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all fitness related activities and/or exercises in which I participate. WHICH THEIRIN INCLUDES ANY AND ALL OUTDOOR SESSIONS AND THE ENVIRONMENT IN WHICH THEY ARE USED WITH.

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.

This form is an important legal document that explains the risks you are assuming by beginning an exercise program. It is critical that you have read and understand this document completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for clarification prior to signing it.

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Signature Certificate
Document name: Client Release Form
Unique Document ID: a4bd5170e654e5bb7c964b17e33fe56d9227f00a
Timestamp Audit
December 20, 2018 10:48 am CSTClient Release Form Uploaded by Nate Voronyak - nate@evolttraining.com IP 73.50.171.53, 127.0.0.1
April 9, 2019 11:59 am CST Document owner info@evolttraining.com has handed over this document to nate@evolttraining.com 2019-04-09 11:59:04 - 73.50.171.53, 127.0.0.1