Name

Last Name

Age

years

Height

cm

Weight

kg

Whats the activity level after school?
none(seated only)Moderate (light activity such as walking)High (Recreational sport, very active)

Please list the physical activities that you participate in outside of school if applicable?

If you have any diagnosed health problems list the condition(s).

What additional therapies are being undertaken for the given health problem(s)?

If you are on any medications, please list them.

What additional therapies are being undertaken for the given injury?

If you have any injuries, please list them.

What following goals does best fit in with your goals?
Improved tumbling skillsImproved enduranceIncreased strengthIncreased flexibilitySpeedAgilityBuild self confidence

What is your goal with your training?

How often are you willing to train a week to reach your goal?

At what times during the day would you prefer to train?
MorningMid-DayAfternoon

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less
than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

All session shall be agreed upon between trainer(s) and clients.Sessions will not be extended (unless time is
available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any
necessary medical advice. I understand that all the information given will be kept confidential.