Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Are you currently exercising on a weekly basis? *

Yes

No

How many times a week do you workout? *

Anything that gets your heart rate up for at least 30 minutes

0- 1

1- 2

3- 4

5- more

Have you ever Boxed | Kickboxed before? *

Yes

No

Have you ever worked out with a personal trainer? *

Yes

No

General Health | Please check any that apply: *

Over 69 and not accustomed to vigorous exercise

Any medications that would hinder your exercise performance

Any reason(s) you should not be doing physical activity

Are you Pregnant

Do you have a known heart condition

Pain in chest during physical activity

Chest pain within the last month without physical activity

Loss of balance because of dizziness or loss of consciousness

Pulmonary artery disease, such as asthma or emphysema

Bone or joint problems, such as arthritis

Heart condition or blood pressure medication

Are you diabetic

None

Student Warranty *

Check box to Agree to Terms

Client warrants that he or she is in good physical condition with no potentially harmful impairments. It is strongly recommended that each client undergo a physical examination and discuss a program of exercise with a physician before beginning any exercise programs with a trainer. You agree that J5 NYC, LLC dba J5 FITNESS shall not be liable or responsible for any and all claims relating to any injuries resulting from your training routine with Jennifer Santiago. For avoidance of doubt, this is a legal release: by signing below, you agree to release and discharge J5 NYC, LLC dba J5 FITNESS and its principals, employees, agents, and assigns from any and all claims, actions, and judgments, whether in law or equity, which you or your heirs, executors, administrators or assigns may have for any injuries or damages to your person or property which you may suffer in connection with training under J5 NYC, LLC dba J5 FITNESS. Under all circumstances client agrees to train with trainer, Jennifer Santiago, at his or her own risk.

Training Policy *

Check box to Agree to Terms

Cancellation Policy: 24 hour cancellation notice is required. Clients will be charged for no-shows or inadequate notice. Training Session Expiration: All Packages will expire (1) one year from purchase date. Refund Policy: Personal Training sessions are not refundable. Payment: Please pay by approved payment method: preferably Cash, Check, or Zelle (j5fitnessnyc@gmail.com) | credit/debit card accepter service fee included. Make all payments to J5 Fitness or Jennifer Santiago.