Please read every section, initial where indicated, and sign at the end. This form works together with our Health Disclaimer. Print it, complete it by hand, and bring or mail it to Chris Jamison Sr., Nspired Greenville, 2123 Old Spartanburg Rd, PMB 343, Greer, SC 29650, or email a scan to chris@example.com, before your first session. Questions? Call (864) 555-0100.
1. Client information
Services I plan to use (check all that apply):
2. Health history questionnaire (PAR-Q style)
Please answer each question honestly. Check YES or NO.
| Question | Yes | No |
|---|---|---|
| 1. Has a doctor ever said you have a heart condition or high blood pressure? | ||
| 2. Do you feel pain or pressure in your chest at rest, during daily activities, or when you are physically active? | ||
| 3. In the past 12 months, have you lost your balance because of dizziness, or lost consciousness (fainted)? | ||
| 4. Have you been diagnosed with another chronic medical condition (for example diabetes, kidney disease, lung disease or asthma, cancer, or arthritis)? | ||
| 5. Are you currently taking prescription medication for a chronic medical condition? | ||
| 6. Do you have, or have you had in the past 12 months, a bone, joint, muscle, or back problem that could get worse with more physical activity? | ||
| 7. Have you had surgery, a hospital stay, or a serious injury in the past 12 months? | ||
| 8. Are you pregnant, or have you given birth in the past 12 months? | ||
| 9. Do you get short of breath more easily than others your age, or have trouble breathing during light activity? | ||
| 10. Has a doctor ever said you should only do medically supervised physical activity, or told you to limit your activity? | ||
| 11. Do you know of any other reason you should not take part in physical activity? |
If you answered YES to any question, please talk with your physician before starting. Nspired Greenville may require written medical clearance before you begin or continue training.
I confirm that the information above is true and complete to the best of my knowledge. I will tell my coach right away if my health, medications, or physical condition change.
Client initials:
3. Informed consent
I am voluntarily choosing to take part in fitness training and health coaching with Nspired Greenville and Chris Jamison Sr.. This may include body weight exercises, free weights and gym equipment, cardio and interval work, stretching, bike rides, hikes, and coaching on habits such as nutrition, sleep, and stress. The purpose, general methods, and possible risks have been explained to me, and I have had the chance to ask questions.
I understand that I can stop or modify any exercise at any time, and that I should tell my coach about any pain, discomfort, or unusual symptoms. I have read and understand the Health Disclaimer, including that coaching is not medical advice and that results are not guaranteed.
Client initials:
4. Assumption of risk
I understand that exercise and outdoor activity involve risks, including but not limited to:
- muscle soreness, strains, sprains, pulled muscles, and joint injuries;
- broken bones, cuts, bruises, and head injuries from falls, dropped weights, or equipment;
- dizziness, fainting, dehydration, heat exhaustion, and heat stroke;
- abnormal blood pressure or heart rhythm, heart attack, stroke, and, in rare cases, death;
- injuries caused by my own actions, by equipment, by other people, or by conditions I cannot control.
Knowing these risks, I choose to participate and I voluntarily assume all risks of injury, illness, or loss, whether known or unknown, to the fullest extent permitted by law.
Client initials:
5. Virtual session terms (Zoom, or FaceTime as an alternative)
For virtual sessions, I understand and agree that:
- I am responsible for choosing a safe space to exercise, with enough room, good lighting, a stable non-slip surface, and no tripping hazards, sharp edges, children, or pets in the way.
- I am responsible for the condition and safe use of my own equipment (for example dumbbells, bands, mats, steps, benches, or bikes).
- My coach cannot physically spot me or adjust my form, and can only see what my camera shows. I will position my device so my coach can see me when asked.
- I will keep water and a phone nearby, and I will stop if anything feels unsafe.
- Virtual sessions are held on Zoom using the meeting link my coach provides. I will not share that link with others. FaceTime may be used as an alternative when agreed.
- Internet or video problems may interrupt a session. If the connection drops, I will stop exercising until it is restored.
- I will not record sessions without my coach's permission.
Client initials:
6. Outdoor activity terms (bike rides and hikes)
For outdoor sessions, I understand and agree that:
- Outdoor activities carry added risks, including heat, humidity, cold, rain, storms, lightning, uneven or slippery terrain, roots, rocks, hills, water crossings, traffic on roads and crossings, other cyclists and trail users, dogs and wildlife, insects (including ticks and stinging insects), poison ivy, falls, getting lost, and being far from emergency help or cell service.
- I will wear an approved, properly fitted helmet on every bike ride, and I will follow traffic laws, posted trail rules, and my coach's instructions.
- I am responsible for making sure my own bicycle and gear are in safe working condition, unless equipment is provided to me.
- I will wear suitable shoes and clothing, bring water, and tell my coach about any allergies, including insect sting allergies, and bring any prescribed medication (such as an inhaler or epinephrine auto-injector).
- My coach may change, shorten, move indoors, or cancel any outdoor session because of weather, air quality, trail conditions, or safety concerns.
- Public parks, roads, and trails are not owned or controlled by Nspired Greenville.
Client initials:
7. Release of liability and waiver
In exchange for being allowed to take part in services offered by Nspired Greenville, I, for myself and for my heirs, family, estate, and anyone who may claim on my behalf, release, waive, and discharge Nspired Greenville, Chris Jamison Sr., and their owners, employees, contractors, and agents (the "Released Parties") from any and all claims, demands, and causes of action for injury, illness, death, or property loss or damage arising out of or related to my participation, including claims arising from the ordinary negligence of the Released Parties, to the fullest extent permitted by South Carolina law.
This release does not apply to claims caused by gross negligence or willful or intentional misconduct of the Released Parties.
This release covers all sessions and services, whether virtual, in a gym, or outdoors, now and in the future, unless I revoke it in writing.
Client initials:
8. Indemnification
I agree to indemnify, defend, and hold harmless the Released Parties from any claims, losses, costs, or expenses (including reasonable attorney's fees) brought by me or by anyone else that arise from my participation, my actions, or my failure to follow instructions or safety rules, to the fullest extent permitted by law.
Client initials:
9. Emergency medical authorization
If I am injured or become ill and am unable to give consent, I authorize my coach to call 911 or emergency medical services, give basic first aid or CPR, and contact my emergency contact listed above. I consent to emergency medical evaluation and treatment by qualified medical personnel.
I understand that I am responsible for any costs of emergency services, transportation, and medical treatment. I understand that Nspired Greenville does not provide medical or health insurance coverage for clients.
Client initials:
10. Media release (optional)
From time to time Nspired Greenville may take photos or video during sessions for use on its website, social media, and marketing. This section is optional and does not affect your ability to train with us. Please initial ONE line:
I AGREE that my photo, video, voice, and first name may be used for these purposes, without payment to me. Initials:
I DO NOT AGREE to the use of my photo, video, or name. Initials:
I may change my choice at any time by notifying Nspired Greenville in writing. Changes apply going forward.
11. Payment and cancellation acknowledgement
Payments are processed securely online through Stripe or another method approved by Nspired Greenville.
[Insert your cancellation, rescheduling, late arrival, no-show, refund, and package expiration policy here.]
I have read and agree to the payment and cancellation policy above.
Client initials:
12. Minor participants
Clients under 18 years of age may only participate with the written consent of a parent or legal guardian. The parent or guardian must complete and sign this form on the minor's behalf. By signing below, the parent or guardian confirms that they have legal authority to sign for the minor, consents to the minor's participation, agrees to all terms of this form on the minor's behalf and on their own behalf, including the assumption of risk, release, indemnification, and emergency medical authorization, and agrees to supervise or arrange appropriate supervision as required by Nspired Greenville.
13. General terms
Governing law
This agreement is governed by the laws of the State of South Carolina. Any dispute will be brought in the state or federal courts located in Greenville County, South Carolina.
Severability
This agreement is intended to be as broad and inclusive as South Carolina law allows. If any part is found to be invalid or unenforceable, the rest of the agreement will remain in full force and effect.
Entire agreement
This form, together with the Health Disclaimer, is the entire agreement between me and Nspired Greenville about these subjects. I am not relying on any oral statements or promises not written here.
14. Acknowledgement and signatures
I HAVE CAREFULLY READ THIS ENTIRE FORM AND I UNDERSTAND IT. I UNDERSTAND THAT BY SIGNING IT I AM GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE FOR INJURIES CAUSED BY ORDINARY NEGLIGENCE. I AM SIGNING VOLUNTARILY AND I AM AT LEAST 18 YEARS OLD, OR MY PARENT OR LEGAL GUARDIAN IS SIGNING FOR ME.