Name
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First Name
Last Name
Email
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Phone
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(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
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MM
DD
YYYY
Weight
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Height
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Emergency Contact Information
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First Name
Last Name
Phone
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(###)
###
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Email
Relationship
What are your primary Fitness goals?
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Why are they important to you?
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Are you currently exercising on a weekly basis?
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How many times a week do you workout?
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Anything that gets your heart rate up for at least 30 minutes
What type of training do you typically do?
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Have you ever worked out with a personal trainer?
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Preferred training time and day:
Have you ever Boxed | Kickboxed before?
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General Health
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Current Health Conditions | Please check all that apply:
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Past Injuries or Surgeries | Please check all that apply:
Please list any injuries or surgeries you’ve had in the past, and explain any current limitations or recovery status.
Comments section
Update Medical Reminder
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Fitness Waiver and Release Form
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I confirm that I am in good physical condition and have no impairments that could affect my ability to safely participate in the fitness program at J5 NYC, LLC dba J5 FITNESS whether in-person, virtual, or during any outside training sessions. I acknowledge and understand that physical activity, including in-person, virtual, or outdoor training, involves inherent risks, including but not limited to physical injury, permanent disability, or even death. I voluntarily accept and assume these risks.
I acknowledge that it is strongly recommended I seek medical clearance from a physician before beginning any exercise program, especially if I have any pre-existing medical conditions. I certify that I am physically capable of participating in the program, and agree to notify the trainer if I experience any injuries, discomfort, or limitations.
I release and discharge J5 NYC, LLC dba J5 FITNESS, its owners, instructors, agents, and employees, from any and all claims, actions, damages, or causes of action, including negligence, that may arise from my participation in any fitness activity, whether in-person at the studio, virtual, or outdoor training sessions.This includes claims arising from the negligence of the released parties. I agree to train at my own risk and understand that J5 NYC, LLC dba J5 FITNESS is not liable for any injuries resulting from my training routine.
I further agree to follow all instructions provided by the fitness instructors, use equipment and facilities safely whether in-person, virtual, or any outside training sessions, and behave respectfully toward instructors, staff, and fellow participants. Any inappropriate behavior may result in immediate expulsion from the program without refund.
Training Policy
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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: Training sessions are not refundable.
Payment: Payments can be made via Cash, Check, Zelle (j5fitnessnyc@gmail.com). A service fee may apply for credit/debit card payments. Make all checks payable to J5 Fitness or Jennifer Santiago.
