Fitness Planning Consultants, Inc.

The next Class starts Monday, June 4, 2012 at 7pm. We are starting a waiting list after the first 10 participants so hurry and fill out your form..

To secure your spot, please complete this form. You will then be forwarded to a PayPal page to complete payment, by choosing which payment option you'd like. Your spot won't be completed, until we receive payment. If you have any questions, please don't hesitate to call at (614) 460-5348.

We hope you enjoy the class.

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Phone Number (Home):
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Date of Birth:
Primary Physician's Name:
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How did you hear about us (be specific)?:
If referred: please tell us by whom, so we can thank them:
What inspired you to start our program TODAY?!
What do you absolutely want to accomplish with this program?:
Have you had previous workout experience? Please list in detail your previous exercise programs:
What are your upcoming big races you want to do well for this year?:
Please list any illnesses, aches, pains, medical conditions, that could manifest during our training. Please describe in detail:
Are you on any medications? If so, please list:
Do you have any allergies to medications? If so, please list:
Any other notes you need to tell us:
Please checkmark the following:
I agree not to use foul or offensive language of any kind
I will remember to set my alarm and be at class on time. I will not be allowed to participate if I arrive more than 10 minutes after the official start of that workout, as I will have missed the critical group warm-up. I understand that this warm-up is an essential part of having both a productive workout and preventing both short-term and long-term injuries. Furthermore, I will only be provided with one “late pass” per month class, unless there are extenuating circumstances beyond my control as agreed upon by my head coach. I fully understand that if I am more than 10 minutes late on 2 separate occasions during any phase of the program, I will only be allowed to re-join the group during the next month without refund. I agree to come to every workout with the exception of a doctor-approved absence, family emergencies, or a pre-approved absence from a coach.
I will listen to the specialist’s instruction without side talk or interruptions. If you fail to do so and the specialist has to repeat him or herself as a result of this, you will be given one warning. If you continue to be a disruption, then you will be asked to leave the current workout in the best interests of the group. However, please feel free to push and encourage each other during all other times.
I understand that there are no refunds for absences. NO EXCEPTIONS! I am committed to consistently attending the scheduled classes, so this is not a concern for me.
I understand that if I am truly not 100% satisfied with this program, I can receive a 100% money back refund.
I am aware that Fitness Planning Consultants, Inc. may record workouts/ boot camps/classes for later use on television segments, websites, promotional materials, or in any other way they see fit. By checkmarking and submitting this form, I hereby authorize Fitness Planning Consultants, Inc. to use my name and likeness, voice, verbal statements, video taped pictures for any of the aforementioned purposes.
I will have a positive attitude and have fun. I will not use words such as "No" or "Can't", but instead use words such as "I will try my best." I will allow the specialists to encourage and push me to a fitness level that I never imagined.

All participants should have their own insurance for accidental injury. In most instances Family Health is adequate.
Do you have required insurance? Yes No

By submitting this form, you indicate that you agree to the Terms of Use Agreement and have read and understand the Privacy Policy and Medical Disclaimer of the Fitness Planning Consultants, Inc. Fitness Planning Consultants, Inc. shall not be liable to the signee, nor any other person, for any claims or cause of action whatsoever arising out of or connected with the services of Fitness Planning Consultants, Inc.; and that I hereby release and discharge Fitness Planning Consultants, Inc. from any such claims or actions.

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