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------ Document 1 of 9 ------
Independent Contractor Agreement - Personal Trainer
This Agreement is entered into as of the [Date Number] day of [Month], [Year], between [Company Name] (“the Company”) and [Service Provider’s Name] (“the Contractor”)
The Contractor will provide “per hour” Personal Training Instruction for the Company under the terms and conditions as listed below.
1) LENGTH OF CONTRACT
This Contract becomes effective the day it is signed by both parties. It continues in effect until terminated in accordance with the provisions specified in item #7 below, Termination of Contract.
2) INDEPENDENT CONTRACTOR STATUS
It is the express intention of the parties that the Contractor is an Independent Contractor and not an employee, agent, joint ventured, or partner of the Company or any of its affiliates. Nothing in this Contract shall be interpreted, expressed, implied or construed as creating or establishing the relationship of employer and employee between the Company and the Contractor or any employee or agent of the Contractor.
The Contractor will receive a 1099 at year-end mailed to their last known mailing address for the purposes of paying all their Local, State, and Federal Taxes, including Social Security. The Company does not pay any tax liabilities whatsoever in connection with the services provided. As the Contractor, you have no employment relationship with the Company, and are not entitled to typical employee benefits, including Unemployment Insurance, Worker’s Compensation, Disability Insurance, Health and Life Insurance, and/or vacation.
The Contractor retains the right to provide services to others during the term of this Contract and is not required to devote their services exclusively to the Company.
3) QUALIFICATION REQUIREMENTS
The Contractor agrees to have and maintain current CPR Certification and nationally accredited Personal Training Certification.
The Contractor agrees to have instructor certification specific to the programs or types of training to be provided. Prior personal training experience and proven expertise may stand in lieu of certification, contingent upon the Fitness Director’s evaluation of the Contractor’s skills and abilities.
The Contractor understands that the Company does not, and is not, under any obligation to provide any training for the type of service(s) rendered by the Contractor.
4) SERVICES
The Contractor agrees to conduct various types of personal training services, offered by the Company to its’ members, which are designed to improve cardiovascular fitness, muscular conditioning, and/or increase flexibility.
The Contractor agrees to conduct instruction according to the Industry recognized safety standards set by AFTA, ACE, and AFPA. The Contractor is otherwise solely responsible for determining the method and means of providing the above-described services, including, but not limited to, personal attire, equipment, and/or class choreography.
The Company agrees to furnish space and equipment at a designated Company fitness facility for use by the Contractor while performing above-described services.
The Contractor agrees to conduct personal training services on the day and time, as it appears, on their personal calendar.
The Contractor shall apply for changes or substitutions in the type, timing, or description of instruction rendered at the Company in writing to the Fitness Director. Changes can only be initiated with the verbal or written approval of the Fitness Director.
The Contractor may use a Substitute, as they deem necessary in order to perform the services required of the Contractor by this Contract. Performance of any service required by this Contract by a Substitute shall be subject to the following terms and conditions:
1. The Contractor shall be solely responsible for arranging their own Substitute and agrees to notify the Company of any substitution in advance by advising the Fitness Director verbally, by email, and/or in writing. The Company Fitness Director shall provide the Contractor, on a regular basis, the most current list of the Company approved Contractors that specialize in personal training.
2. The Contractor shall provide the Substitute with all the information and procedures necessary to successfully perform the service, including but not limited to, the location of all necessary equipment, keys, Sign-In Sheets, Invoice Summary Sheets, and invoicing procedures.
3. Any Substitute personally retained by the Contractor who does not have their own active Independent Contractor Agreement with the Company, shall be deemed to be acting as an agent or employee of the Contractor and shall be subject to all of the terms and conditions set forth in this Contract, including, but not limited to, invoicing the Company for substitute services rendered.
5) PAYMENT FOR SERVICES
A service shall be considered performed or rendered when the service for personal training was conducted, as agreed upon per their calendar. Services cancelled or not performed due to civil or military authority, act of public enemy, accidents, fires, explosions, or acts of God, including, without limitation, earthquakes, floods, winds, or storms shall not be compensated.
In consideration of the services to be provided by the Contractor to the Company, the Company agrees to one of the following payment methods. See Addendum A, Compensation, for details.
1. Contractor will be paid an hourly rate based on the number of paid personal training sessions he performs per month. It is the Contractor’s responsibility to submit the Invoice Summary Sheet for the personal services rendered. Invoice Summary Sheets must include the name of the Contractor, name of person that was trained, the Day, Date, and Time. Payment of invoices will be made according to the following schedule:
Services Rendered Invoice Submitted Payment made
1st – 31st by 2nd of next month 15th of the month submitted
The Contractor shall be responsible for keeping and maintaining their own records regarding services rendered, invoices submitted and payments made. The Company may withhold or delay payment of invoices for improperly documented, incorrectly submitted, or late submitted Invoice Summary Sheets.
2. Contractor agrees to pay Company a flat rate of $000.00 per month whereby he/she can perform their personal training services and charge the member direct. Monthly training fees are due on the 1st and are considered late on the 10th. Fees received after the 10th of the month are subject to a $000.00 late fee.
6) OBLIGATIONS
The Contractor shall be responsible for all costs and expenses incurred by rendering services for the Company, including, but not limited to: all costs of equipment provided by the Contractor, travel expenses, communication expenses, all professional fees, fines, liability insurance, bonds, or taxes required of or imposed on the Contractor by Local, State, or Federal agencies and/or any other costs of doing business. The Company shall not be responsible for any expenses, costs or taxes of any kind incurred by the Contractor in providing services for the Company.
Unless otherwise specified in this Contract, the Contractor will supply all tools, props, and/or instruments required to provide services under this Contract, including, but not limited to, personal attire. The Company shall not be required to provide but shall allow the use of equipment in its facility only as it relates to the type of personal training service being performed by the Contractor. The Contractor shall be required to report any defective, broken, or worn out equipment to the Fitness Director. Upon unsuccessfully locating/contacting the Fitness Director, the Contractor will log all defective, broken, or worn out equipment in the facility Maintenance Binder located at the front desk.
The Contractor agrees to indemnify and hold the Company, its management, employees, agents, officers, and/or affiliates harmless against any and all liability imposed or claimed, including attorney’s fees and other legal expenses, arising directly or indirectly from any act(s) or failure of the Contractor or the Contractor’s assistants, substitutes, employees or agents. This includes all claims relating to the injury or death of any person or damage to any property arising from any actions of the Contractor while providing services for the Company. The Company strongly recommends that the Contractor maintain their own professional liability insurance, with the Company named as an additional insured, for a minimum amount of $1,000,000 to cover any such claims.
The Contractor agrees to provide Worker’s Compensation Insurance for their own employee’s and agent’s, and agrees to hold harmless and indemnify the Company, its management, employees, officers, and affiliates for any and all claims arising out of any injury, disability, or death of any of the Contractor’s employees, substitutes, or agents.
7) TERMINATION OF CONTRACT
This Contract may be terminated without cause, upon submission of a thirty day written notice by either party.
This Contract shall terminate automatically upon the occurrence of the bankruptcy, insolvency, or death or sale of business of either party.
Should the Contractor default in providing services under this Contract or materially breach any of its provisions, the Company, at its exclusive option, may terminate this Contract immediately by giving written notification to the Contractor at its last known mailing address.
For the purpose of this paragraph, material breach of this Contract includes, but is not limited to, the following circumstances:
The Contractor is not qualified to provide personal training services for the level of training or does not have current certification(s).
The Contractor fails to provide the personal training service as published.
The Contractor repeatedly fails to show up for appointments and fails to secure a qualified substitute.
The Contractor consistently averages less than 10 participants per month.
The Contractor fails to conduct training safely or professionally.
The Contractor falsifies the Invoice Summary Sheet.
The Contractor fails to pay month flat rate amount.
The Contractor defames the Company, its management, employees or affiliates in any way, either orally or in writing.
The Contractor’s conduct results in repeated and/or numerous complaints by the Company members.
8) GENERAL PROVISIONS
Any notice required under this Contract must be in writing and can be accomplished either by hand delivery or mail, registered or certified, postage prepaid. Mailed notices shall be addressed to the parties at the addresses appearing on the Signature Page of this Contract. If either party changes its address, written notice of such change must be given immediately to the other party. Notices delivered by hand are deemed communicated as of actual receipt. Mailed notices are deemed communicated as of 3 days after mailing.
If any provision in this Contract is held by a court of competent jurisdiction to be invalid, void or unenforceable, the remaining provisions will nevertheless continue in full force without being impaired or invalidated in any way.
If the Contractor dies prior to completion of the Contract, any monies that may be due the Contractor from the Company under this Contract as of the date of death will be paid to the Contractor’s executors, administrators, heirs, personal representatives, successors, or assigns.
The Contractor agrees to file all necessary governmental documents, including appropriate tax returns, reflecting its income and status as an Independent Contractor for the services rendered to the Company. Should any governmental agency audit the files of the Company and request information about the Contractor, the Contractor agrees to immediately furnish the Company with any records, including tax returns, relating to the services rendered to the Company.
Neither party shall be deemed to be in violation of the Contract if it is prevented from performing any of its obligations hereunder due to civil or military authority, act of public enemy, accidents, fires, explosions, or acts of God, including, without limitation, earthquakes, floods, winds, or storms.
Both parties agree to arbitrate any controversy between them involving the construction or application of any of the terms, covenants, or conditions of this Contract. This Contract shall be governed by and construed under [State] Law. The arbitration will comply with and be governed by the provision of the [State] Arbitration laws. The arbitrator’s decision will be final and conclusive on both parties.
This Contract confirms the terms of the oral agreement and supersedes any and all other contracts, whether oral or written, between the parties regarding the Contractor’s services to the Company. It also contains all the covenants and agreements between the parties regarding the rendering of such services in any manner whatsoever. Each party to this Contract acknowledges that no representations, inducements, promises or agreements, oral or otherwise, have been made by any party, or anyone acting on behalf of any parties, which are not contained in this Contract. If there is any agreement, statement or promise not in this Contract, it shall be void, invalid and non-binding. Any modification of this Contract will be effective only if it is in writing and signed by both parties.
The Company and Contractor entered into this Contract on at , [State]
Date and Year Location
The Company The Contractor
Signature Signature
------ Document 2 ------
Independent Contractor or Employee?
Which is the right one?
For federal tax purposes, this is an important distinction. Worker classification affects how you pay your federal income tax, social security and Medicare taxes, and how you file your tax return. Classification affects your eligibility for employer and social security and Medicare benefits and your tax responsibilities. If you aren’t sure of your work status, you should find out as soon as possible.
The courts have considered many facts in deciding whether a worker is an independent contractor or an employee. These relevant facts fall into three main categories:
behavioral control
financial control and
relationship of the parties.
In each case, it is very important to consider all the facts – no single fact provides the answer. Carefully review the following definitions.
Behavioral Control - These facts show whether there is a right to direct or control how the worker does the work. A worker is an employee when the business has the right to direct and control the worker. The business does not have to actually direct or control the way the work is done – as long as the employer has the right to direct and control the work. For example: Instructions – if you receive extensive instructions on how work is to be done, this suggests that you are an employee. Instructions can cover a wide range of topics, for example: How, when, or where to do the work, what tools or equipment to use what assistants to hire to help with the work, where to purchase supplies and services. If you receive less extensive instructions about what should be done, but not how it should be done, you may be an independent contractor. For instance, instructions about time and place may be less important than directions on how the work is performed with training about required procedures and methods, this indicates that the business wants the work done in a certain way, and this suggests that you may be an employee.
Financial Control - These facts show whether there is a right to direct or control the business part of the work. For example: Significant Investment – if you have a significant investment in your work, you may be an independent contractor. While there is no precise dollar test, the investment must have substance. However, a significant investment is not necessary to be an independent contractor. Expenses – if you are not reimbursed for some or all business expenses, then you may be an independent contractor, especially if your unreimbursed business expenses are high. Opportunity for Profit or Loss – if you can realize a profit or incur a loss, this suggests that you are in business for yourself and that you may be an independent contractor.
Relationship of the Parties - These are facts that illustrate how the business and the worker perceive their relationship. For example: Employee Benefits – if you receive benefits, such as insurance, pension, or paid leave, this is an indication that you may be an employee. If you do not receive benefits, however, you could be either an employee or an independent contractor. Written Contracts – a written contract may show what both you and the business intend. This may be very significant if it is difficult, if not impossible, to determine status based on other facts.
The status of a worker as an employee of a company rather than an independent contractor is important for determining who is to pay the payroll taxes or to wage withholding taxes. If the worker is considered an independent contractor, then the employer would not withhold any taxes from the independent contractor's payments. The employer would provide the independent contractor with gross sums and would submit a 1099 tax form to the IRS reflecting its payments to the Independent Contractor. It would be the Independent Contractors responsibility to maintain its own records and file its forms independently.
If the worker is considered an employee, then the employer is responsible for paying social security, Medicare, and unemployment (FUTA) taxes on the wages. The employer must provide a Form W-2, Wage and Tax Statement at the end of the year, showing the amount of taxes withheld from the employees pay.
Visit the IRS web site at, http://www.irs.gov/businesses/small/article/0,,id=99921,00.html for more detailed information on this subject.
------ Document 3 ------
PERSONAL TRAINING AGREEMENT
Operating Hours: Mon-Thurs 8 am-10 pm; Fri 8 am-9 pm; Sat/Sun 8am-5pm
First Name: ____________________________ Initial: _______ Last Name: _____________________________
Street Address: ______________________________________ City: _______________________ ST: ________
Zip: _________________ Birth Date: ________________________ Email: __________
Home Phone: ____________________ Cell Phone: ____________ Work Phone: ______ Occupation: ___________________________ Employer: ________________________
INFORMED CONSENT: Although there are distinct benefits to exercise in terms of quality and enjoyment of life, strenuous exercise is not without risk to the musculoskeletal and cardiovascular systems. Before using the facility, you and your physician should decide on the appropriateness of exercise given your known risk factors and current state of health. If an exercise feels awkward or causes pain, stop and consult your physician. Pain, discomfort and anxiety have no place in sound fitness activity. I take full responsibility for maintaining an appropriate exercise program, knowing my risk factors and current state of health. In consideration of being permitted to use services and facilities, and to engage in exercise activities, including use of all [Company Name] facilities, (hereinafter "Exercise Activities”), I hereby agree as follows:
1. I hereby release and discharge and indemnify [Company Name], its directors, officers, agents, employees and instructors, and all the equipment suppliers (hereinafter referred to collectively as the “Released Parties”), from any and all liability, claims, demands, or causes of action that I may hereafter have for injuries and damages arising out of my participation in Exercise Activities, including but not limited to, losses caused by negligence of the released parties and shall pay any costs, including attorney's fees, incurred by [Company Name] in enforcing this section.
2. I understand that Exercise Activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate. I expressly and voluntarily assume all risk of death or personal injury sustained while participating in exercise activities whether or not caused by the negligence of the released parties.
NOTICE TO BUYER
You, the buyer, may cancel this agreement at any time prior to midnight of the fifth business day of the health studio after the date of this agreement, excluding Sundays and holidays. To cancel this agreement, mail or deliver a signed and dated notice, or send a telegram, which states that you, the buyer, are canceling this agreement, or words of similar effect. Send the notice to: [Company Name, Address, City, State and Zip Code].
I ACKNOWLEDGE THAT I AM OVER 18 YEARS OF AGE, AND HAVE CAREFULLY READ AND UNDERSTAND AND AGREE TO THIS AGREEMENT, INCLUDING PART II, WHICH IS ON THE BACKSIDE OF THIS AGREEMENT, AND HAVE RECEIVED A COPY OF THIS AGREEMENT.
Date: _____________________ Client Signature: ___________________________
Client Name Please Print: ____________________________________________________________________
Parent or Guardian Signature: _________________________________________________________________
PART II
GENERAL TERMS AND CONDITIONS OF TRAINING AGREEMENT
The following rules and regulations as set forth are part of the Personal Training Agreement and client is obligated to observe and comply with the same (subject to reasonable changes without notice).
HOURS: The hours of operation are posted on the premises. These times are subject to reasonable adjustments and may be changed for holidays, special occasions, or maintenance purposes at the discretion of the facility management.
SIGNING IN: All clients upon entering the facility are required to sign in. Clients from time to time may be asked to furnish additional identification for verification of client’s authenticity.
CHANGE OF SCHEDULE: All clients shall provide reasonable notice of your intent to cancel or change a scheduled Personal Training session. A Twenty-four hour notice is required. Additionally, all clients shall provide us with a way to communicate unexpected schedule changes so that neither of us is unduly inconvenienced.
NON-REFUNDABLE: All personal training sessions are non-refundable and non-transferable.
RETURNED ITEM CHARGE: If my bank rejects any payment, I will pay [Company] or its representatives a return item charge of $15.00.
NON-PAYMENT: If any payment becomes 60 days past due, my entire unpaid balance will become immediately due and payable. I shall be liable for any collection costs, court fees, and reasonable attorney fees.
TAXES: Applicable taxes must be paid in addition to published facility fees, dues and charges.
ADDITIONAL RIGHTS OF CANCELLATION: A client may cancel this agreement for any of the following reasons: (1) In the event of the client’s death, the client’s estate may cancel the Training Agreement. (2) If the client becomes significantly physically or mentally disabled for a period in excess of three (3) months and provides reasonable evidence of illness or disability, including a doctor’s letter. (3) If [Company Name] services or facilities are not available to the client during regular hours for a period of one month or more. (4) If facility permanently discontinues operation. (5) If facility substantially changes the operation. (6) If the client moves his/her residence to a location more than 25 miles from the facility.
SEVERABILITY: In the event any part or parts of this Training Agreement are determined invalid or unenforceable, such part, or parts, shall be severed and the remainder shall be in full force and effect.
EXERCISE CLOTHING: All clients are required to wear appropriate clothing and footwear for the activity in which they are engaging. Sweat suits, gym shorts, and t-shirts are all acceptable for exercising, but street clothes/shoes and jeans are not. Swimsuits are required when using the sauna or the whirlpool, and showers are required before entering.
CONDITIONING FLOOR RULES: For uniformity and safety, clients are not allowed to follow their own program unless they have approval from facility staff. It is expected that all clients will put equipment back in its proper place after using it. If equipment is found to be malfunctioning, please bring it to the immediate attention of facility staff. Clients may not use free weights on machines or lay free weights on carpet or benches. As a courtesy to others, clients should wipe off benches after use. Clients should not linger on the equipment because other clients may want to use it. If there is a sign-up list for the use of the equipment (i.e., StairMasters/treadmills) and a maximum time limit on its use, Facility staff expects all clients to follow the rules. If there is a conflict over use, Facility staff will resolve it.
SPA AREA RULES: Clients must shower before entering the sauna or whirlpool. While using spa amenities, clients must wear a swimsuit. Lotions, creams, and sponges are not allowed in the sauna or whirlpool. As a safety measure, use of water or liquids on the sauna rocks is prohibited.
LOCKERS: Lockers are available on a daily basis only. The facility staff suggests that clients use a lock to protect valuables. All items must be removed from the locker after each workout. Items left in the locker overnight will be removed, and the facility assumes no liability for such items. Changing booths are provided. Clients should not leave clothing or valuables in the booths as they are for the use of all clients. Clothing and valuables should be secured in a locker for their protection and safety.
NO ALCOHOL, DRUGS, STEROIDS, OR SMOKING: Clients cannot use the facilities or engage in any activity on Facility premises while under the influence of drugs, alcohol, or medication. Also, we do not permit alcohol, illegal drugs, or steroids in our facilities. Besides the health hazards of steroid use, it is illegal to aid or abet in the unlawful sale, use, or exchange of anabolic steroids, testosterone, and human growth hormones. In keeping with good health, we do not permit smoking in our facilities.
FOOD AND BEVERAGES: Clients cannot take or consume food or beverages in the facilities. Water in an appropriate container is acceptable.
CONDUCT: The Facility does not tolerate any inappropriate conduct on its premises. Such conduct includes, but is not limited to, using loud, abusive, offensive, insulting, demeaning language or profanity or any conduct that harasses or is bothersome to clients or staff.
VIOLATION OF RULES: If any client fails to follow the rules and regulations, the violation may result in the cancellation of client’s privileges.
INJURY OR ACCIDENT: Any client or guest injuries or accidents must be reported immediately to the manager. An accident report will be completed and will be filed at the Main Office.
SUNTANNING: As an additional service to our clients, tanning beds are offered by appointment only. Use of the tanning beds is not included in the price of the Training Agreement, and an additional fee must be paid for use of this service. We may change the fee for this service from time to time without notice. There will be no refunds on unused services, and services cannot be transferred or sold to a non-client. A copy of the sun tanning rates and rules and regulations will be provided upon request.
OTHER ADDITIONAL SERVICES: From time to time, other additional services may be made available to our clients. Specific times and dates will be posted. These additional services are not included in the price of the Training Agreement, and an additional fee may need to be paid by the client in order to participate.
If you have any questions or require additional information regarding the above rules and regulations, please feel free to ask one of the staff.
------ Document 4 ------
GOAL ASSESSMENT
1. What made you decide to embark on an exercise program at this particular time? How long have you wanted to? ________________________________________________________________
________________________________________________________________
2. Briefly list the major and secondary goals you hope to achieve through the service of a personal trainer: ___________________________________________________________________________________________________________________________________
3. Rate from number 1-10 (10 the best). Circle the number that best corresponds to your attitude about your body.
a. Strong 1 2 3 4 5 6 7 8 9 10
b. Hearty 1 2 3 4 5 6 7 8 9 10
c. Healthy 1 2 3 4 5 6 7 8 9 10
d. Attractive 1 2 3 4 5 6 7 8 9 10
e. Fit 1 2 3 4 5 6 7 8 9 10
4. Circle the number that best corresponds to your attitude about exercise.
a. Fun 1 2 3 4 5 6 7 8 9 10
b. Exciting 1 2 3 4 5 6 7 8 9 10
c. Important 1 2 3 4 5 6 7 8 9 10
d. Attractive 1 2 3 4 5 6 7 8 9 10
5. When I do not exercise as often as I should, it’s usually because
________________________________________________________________________________________________________________________________________________________________
6. From 1-10 rate the level of commitment you think you will need to become more physically fit (10 being the highest):
1 2 3 4 5 6 7 8 9 10
7. How much time do you think you would need to invest per week in a sound exercise program? For how long? _______________________________________________________________________
__________________________________________________________________________________________________________________________________________________
8. How much time are you realistically willing to invest per week?
Days: _________________________________________________________________________
Hours: _________________________________________________________________________
9. How does being sweaty make you feel? ______________________________________________
_________________________________________________________________________
10. Challenging the cardio-respiratory system often results in feelings of physical discomfort as the body attempts to supply adequate oxygen for the physical task. From 1-10 rate which number correlates best to the words below and your feelings while under physical stress.
a. Challenged 1 2 3 4 5 6 7 8 9 10
b. Weak 1 2 3 4 5 6 7 8 9 10
c. Defeated 1 2 3 4 5 6 7 8 9 10
d. Afraid 1 2 3 4 5 6 7 8 9 10
e. Determined 1 2 3 4 5 6 7 8 9 10
11. What is your fitness goal? _______________________________________________________
_________________________________________________________________________
12. Do you think you can achieve it? __________________________________________________
_________________________________________________________________________
13. Is the goal something you think you OUGHT to do or WANT to do? ______________________
_________________________________________________________________________
14. Why is the goal important to you? _________________________________________________
_________________________________________________________________________
15. Have you already tried to achieve this goal? _________________________________________
16. What activities do you like? Dislike? _______________________________________________
_________________________________________________________________________
17. Do you think you need to examine your diet? ________________________________________
18. Do you think you need to lose weight? ______________________________________________
Additional notes: ______________________________________________________________________
____________________________
------ Document 5 ------
HEALTH HISTORY FORM
Last Name: ____________________ First Name: ___________________ Initial: _______
Address: _________________________________________________________________
Telephone Number: Business: _________________________ Home: ________________
In Case of Emergency, Contact: ________________________ Phone: ________________
Personal Physician: ____________________________ Phone: _____________________
Age: _________________Date of Birth: ____________________Weight: Height: _______
The health history form is designed to help identify individuals for whom physical activity might be inappropriate at the present time. It is not intended to substitute for a complete physical examination and assessment by a physician. It is recommended that each client undergo a medical examination prior to the initiation of an exercise program. With this understanding, please answer the following questions accordingly.
GENERAL HISTORY
1. Do you currently have an illness or infection? _______ If yes, explain: _________________________________________________________________________
2. Have you been hospitalized or had major surgery within the last year? _____ If yes, explain: _________________________________________________________________
3. Are you pregnant or have you given birth within the last two months? _________
4. Do you have a history of the following conditions? _________ (Check all that apply)
Thyroid Disorders Emphysema Family History of Heart Disease
Liver Disorders Hernia Arteriosclerosis
Kidney Disorders Smoking Heart Attack
Asthma High Blood Pressure (above 90/140 Irregular Heart Beat
Bronchitis High Blood Cholesterol (above 200) Migraines
5. Do you have any other medical condition not previously mentioned? _________ If yes, explain: __________________________________________________
6. Do you have a history of the following injuries or orthopedic problems?
Joint Problems Tendonitis
Arthritis Bad Back
Bursitis Bad Knee
7. Are you currently receiving physical therapy? _________ If yes, explain: ____________________
_________________________________________________________________________
8. Are you currently taking any medication? _________ If yes, list medication and condition _______
_________________________________________________________________________
9. Describe your current stresses: _____________________________________________________
_________________________________________________________________________
10. Are you presently involved in an exercise program? _________ If yes, please specify activity, frequency, and duration: ____________________________________________________________
_________________________________________________________________________
11. In order to help design a program enjoyable to you, please select from the following list of activities and equipment of particular interest:
Body Building Free Weights
Strength Training Machines
General Fitness Training Circuit Training
Cardiovascular Biking
Flexibility Stairrnaster
Weight Loss Treadmill
Other Other
12. What exercises do you hate? ____________________________________________________
_________________________________________________________________________
I acknowledge, to the best of my ability, that I have answered the above questions completely and honestly, and reaffirm that I have no known medical problems that would restrict my ability to participate in this exercise program. I also understand that any physical activity involves risks. Therefore, I do hereby waive, release, and forever discharge the 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.
_________________________________________ ___________________________
Signature of Trainee Date
_________________________________________ ___________________________
Signature of Personal Trainer Date
------ Document 6 ------
Physical Activity Readiness Questionnaire
(PAR-Q)
A Questionnaire for People Aged 15 to 69
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. Being more active is 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.
Physical Activity Readiness Questionnaire YES NO
Has your doctor ever said that you have a heart condition and that you should do only 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 to 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 that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow your doctor’s advice.
If you answered “no” to all 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 your basic fitness so that you can plan the best way for you to live actively.
Do you need to delay becoming much more active?
If you are not feeling well because of a temporary illness such as a cold or a fever, wait until you feel better. If you are or may be pregnant, you may want to 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 your physical activity plan.
Informed Use of the PAR-Q:
[Company Name] assumes no liability for persons who undertake physical activity. If you are 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.
Signature _________________________ Please Print __________________________
------ Document 7 ------
Personal Training Program - Physician’s Exercise Clearance Form
(Please return this form once completed and signed by your physician)
The exercise programs at [Company Name] are professionally supervised. Participants receive a one-on-one health assessment with a Certified Personal Trainer. The Training Center staff will design an exercise program based on the individual’s needs and personal goals. The programs include cardiovascular conditioning, flexibility exercises, muscular strengthening exercises, and instruction on body mechanics and balance exercises as needed.
Our staff is concerned about our participants. We ask that every person who enrolls in our exercise programs fill out a Physical Activity Readiness Questionnaire.
Your patient __________________________________ has indicated in their Physical Activity Readiness Questionnaire that they have one or more medical risk factors, which may impair their ability to exercise safely. For this reason, you are being asked to complete the following information before your patient can participate in our program.
Patient: ______________________ Patient’s Home # __________________________ Wk# _______________________ Date of last physical examination: _______________
Based upon your medical knowledge of this patient, please list any restrictions he or she must follow. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If you do not concur with your patient’s participation in an exercise program, please list the reasons why below.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Based upon my medical knowledge of ___________________________________ and subject to any restrictions listed above, I am unaware of any condition that would preclude he/she from participating in this exercise program.”
_________________________________________ ___________________________
Physician’s Signature Date
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PERSONAL TRAINER SUBSTITUTE SCHEDULE
Guidelines for Finding Substitute Trainers
1. After determining the session or sessions you need covered, use the [Company Name] Personal Trainer Directory to contact trainers who may be able to train your client.
2. Upon finding a substitute, call [Company Name] (555-1234) to inform the front desk staff of the changes in your schedule. This will allow them to post the name of the trainer filling in for your session.
3. If you are unable to make arrangements for a substitute after placing the appropriate calls, call [Company Name] for assistance.
4. If you need a substitute on an emergency basis, or if you are unable to make calls to locate an trainer, call the [Company Name] staff for assistance.
5. You may post notes in the staff book for substitute recruitment as long as you make follow-up efforts to locate a trainer and notify [Company Name] as to your schedule changes.
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Client Consent Form
By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive physical exercise.
I also acknowledge that I have been informed of the need to obtain a physician's examination and approval prior to beginning this exercise program. In signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including but not limited to abnormal blood pressure, fainting, heart attack or even death.
I also understand that I may stop any training session at anytime. By signing this document, I assume all risk for my health and well being and any resultant injury or mishap that may affect my well being or health in any way and hold harmless of any responsibility, the instructor, facility or persons involved with the program and testing procedures.
Print Name: _________________________________________
Signature: _________________________________________
Date: _________________________________________
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