Iron Arena Prospective Client Questionnaire

The purpose of this questionnaire is for you to inform me of your past and current physical state as well as your training history.  Please answer the following questions concisely, completely, and truthfully. 

PHYSICAL HISTORY
Name *
Name
Phone *
Phone
Address *
Address
Do you currently have any illness or infection of any kind that might inhibit your ability to train? *
Do you currently take any medications that might inhibit your ability to train? *
Have you ever sustained any major injuries? *
(Arthritis, Bursitis, Tendinitis, shoulder, knee, hip, or lower back pain, etc?)
Training-Specific Questions
Totals days include days you would train with a coach at Iron Arena as well as days where you would train on your own with your workouts written out for you
Specific days you wish to train in a coached setting *
By coached environment I mean supervised in small group or one-on-one
Please list the numbers you’re hoping for and the dates in which you’d like to achieve them.
What motivates you? *
In other words, are you currently in good physical condition or has it been a while since you’ve consistently trained hard?
Agreement and release of Liability
Please read the waiver below
In consideration of being allowed to participate in the activities and programs offered by Iron Arena LLC., and to use its programs and training, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge and hold harmless Iron Arena LLC. from any and all responsibility, liability, cost and expenses, including injuries or damages, resulting from my participation in any activities, or my use of any programs designed by Iron Arena LLC. I do also hereby release Iron Arena LLC. from any responsibility or liability for any injury or damage to myself, or in any way arising out of or connected with my participation in any activities with Iron Arena Powerlifting & Performance or the use of any equipment of Iron Arena Powerlifting & Performance.