Lifestyle Coaching Application
Hello and welcome! If you've made it this far, chances are you're interested in reclaiming control of your lifestyle and fitness experiences.

Using the information from this form and your assessment, I will work diligently to determine the metrics that will translate to you improving your fitness and finding success.

Before you continue, please read this 10 point checklist….

1. ​YES, I understand that the best results come from long-term, focused effort. I understand that I'm committing to a minimum of 3 months of coaching, from which I can continue with coaching, though not required.
 
​2. YES, I understand that my program is tailored towards my needs.
 
​3. YES, I understand Coach Connor will answer messages within a 36-hour period via in-app messaging or email, and I will return the same courtesy. 
 
4. YES, I understand I need to follow the program with 100% focus and commitment. If at any time I am not compliant with the program, I can be let go.
 
5. ​YES, I understand I will need to provide feedback via photos, measurements, and feedback to get the most out of this program and your abilities to coach me effectively.
 
6. YES, I understand that my investment of $99/month for 3 months covers all costs for constructing and delivering my program, hours of communication, and/or accountability calls. With that being said, I’m aware I can ask for additional coaching for an additional cost.

7. YES, I understand I need the proper resources at my disposal based on my goals. For example, I won't say I want to get stronger if I claim to not have any weights to train with or that I want to lose body fat but I'm unwilling to address my nutritional habits.
 
8. YES, I understand that your time is valuable, and complaining, substitutions, and excuses are not tolerated.
 
9. YES, I understand that it takes ownership of myself to give all my effort, dedication, drive, and commitment.
 
10. YES, I believe I am an excellent fit for this program and ready to invest in myself.

With all of this understood, the questions below will be step one in providing me the details and understanding of your health and fitness history. This information will help me serve you with the best possible plan and insight into you as an individual. Please answer all questions honestly and with as much detail as you feel is necessary.

Once you complete the form, I'll be in touch to schedule our consultation over Zoom. I'm looking forward to working together!
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Today's Date *
MM
/
DD
/
YYYY
Height *
Weight *
Date of Birth *
MM
/
DD
/
YYYY
How did you hear about Lifestyle Coaching? *
In detail, please share your current and long-term goals.  *
Why are these your current and long-term goals?  *
How long have you been thinking about working towards these goals? *
Which of the following would improve your life? *
Required
Please describe your fitness/sport history? *
Please provide details of your current fitness routine. *
Please list the type of equipment access you have for exercising? (at-home equipment or access to box gym equipment, etc.)  *
How would you rate your current fitness level? *
Novice
Superhero
How would you rate your goal fitness level? *
Novice
Superhero
Are you currently taking any supplements?  *
Do you have any food allergies or sensitivities?  *
If you were accepted into the program, what would winning look like to you? *
What is your preferred way to receive critical feedback?  *
What are you looking for in me as your Coach? *
Required
Have you ever worked with a Coach prior to now? *
If yes, describe the experience?
Please indicate any of the following that apply to you: *
Required
Please briefly elaborate or specify details on any of the above that is important to share.
Are there any specific daily movements or exercises that cause you discomfort? (cause pain, too risky) *
Is there any other relevant information you'd like to share?  *
How would you rate your anticipation for this coaching experience? *
Meh ...
I'm ready for this!
LIABILITY WAIVER
Please read this agreement thoroughly before submitting your application. No refunds will be issued after receiving your initial training program and/or any other training material.

“Service Provider” refers to Connor Clark Fitness LLC.
“Client” refers to the individual entering into a client-coach relationship with any authorized agent of the service provider.

Liability Release
a. The Client hereby releases, indemnifies, and holds harmless, the Service Provider from any and all manner of actions, causes of action, suits, proceeding, debts, dues, contracts, judgments, damages, claims and demands whatsoever in law or equity stemming from the agreement between the above-mentioned parties.

b. The Client expressly agrees that this release, waiver, and indemnity clause are intended to be as broad and inclusive, and if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

c. I have no known physical or mental condition that would impair my capability to participate fully, as intended or expected of me.

d.  I have carefully read the foregoing release and indemnification clause and understand the contents thereof.

e.  I fully understand the risk of participating in physical activity and agree that the Service Provider shall not be held liable in the case of any training related injury or death.

f. The Clients assumption of risk includes, but is not limited to, use of any exercise equipment (mechanical or otherwise), sports fields, turf areas, sidewalks, parking lots, stairs, lobby or other general areas of any facilities, or any equipment.

g. The Client is aware and agrees that by executing this waiver and release, you are giving up your right to bring a legal action or assert a claim against the Service Provider, or for any defective product used while receiving personal training from Service Provider. You have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

h. The Client agrees to having pictures and videos taken of them during training sessions, to be used by the Service Provider for promotion and content creation.

General Provisions
a. The Client acknowledges that before training, implementing, or using any and all of the recommendations provided, the Client should consult a physician.

b. The client acknowledges that he/she is not authorized to disseminate, share, convey or transfer any recommendation, either orally or written, provided by the Service Provider without his expressed written consent.

c. It is the responsibility of the Client to adhere to their training regimen and inform the Service Provider of any issues or concerns that may inhibit the Client from completing the said regimen.

AGREEMENT *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy