Questionnaire

Full Name

Email Address

Phone Number

Age

Gender Gender Male Female Other

What is your sport? (If you do not compete in a sport please mark N/A)

What is your occupation?

What are your goals for training? Be as specific as possible!

Do you have any limitations to what you can do in training? ex. Old injuries that inhibit you from doing certain exercises? ANYTHING you can think of is helpful.

What are your hopes for hiring a coach? - Do you have any specific expectations from this process?

Brief summary of your current training / training history (Are you fairly consistent going to the gym, what kind of workouts do you generally like to do / not like to do)

How did you find Coach Dusseault Conditioning?

WAIVER OF LIABILITY. I understand and acknowledge that the training, programs and any activities occurring with Coach Dusseault Conditioning may expose me to many inherent risks, including accidents, injury, illness or even death. I assume all risk of injuries associated with participation in such training, programs or activities including, but not limited to, falls, contact with other participants, the oversight and activities with a personal trainer (virtual or in person) and all other such risks being known and appreciated by me.I acknowledge my responsibility in communicating any physical and psychological issues that might affect my participation in activity. I acknowledge that I am physically and mentally fit and capable of performing the physical activity that I choose to participate in with Coach Dusseault Conditioning.I agree, on my own behalf, and on behalf of my heirs, successors, executors, to indemnify and hold harmless Coach Dusseault Conditioning, its directors, officers, agents, employees, representatives, successors and assigns from any responsibility, liabilities, demand, claims, actions of any kind arising out of my participation in any training, programs or activities with Coach Dusseault Conditioning.INDEMNITY AND LIABILITY I acknowledge that I am responsible for ensuring that I correctly operate or use any facilities and/or equipment (including adjusting levels or settings) which is provided by Coach Dusseault Conditioning. I accept the responsibility that in the event I have any doubt about how to correctly operate any equipment, I must consult a personal trainer or one of the Coach Dusseault Conditioning representatives before use. WAIVER OF LIABILITY. I understand and acknowledge that the training, programs and any activities occurring with Coach Dusseault Conditioning may expose me to many inherent risks, including accidents, injury, illness or even death. I assume all risk of injuries associated with participation in such training, programs or activities including, but not limited to, falls, contact with other participants, the oversight and activities with a personal trainer (virtual or in person) and all other such risks being known and appreciated by me.I acknowledge my responsibility in communicating any physical and psychological issues that might affect my participation in activity. I acknowledge that I am physically and mentally fit and capable of performing the physical activity that I choose to participate in with Coach Dusseault Conditioning.I agree, on my own behalf, and on behalf of my heirs, successors, executors, to indemnify and hold harmless Coach Dusseault Conditioning, its directors, officers, agents, employees, representatives, successors and assigns from any responsibility, liabilities, demand, claims, actions of any kind arising out of my participation in any training, programs or activities with Coach Dusseault Conditioning.INDEMNITY AND LIABILITY I acknowledge that I am responsible for ensuring that I correctly operate or use any facilities and/or equipment (including adjusting levels or settings) which is provided by Coach Dusseault Conditioning. I accept the responsibility that in the event I have any doubt about how to correctly operate any equipment, I must consult a personal trainer or one of the Coach Dusseault Conditioning representatives before use. I Agree I Disagree