BOOK YOUR SESSION

Book Janis Saffell for a private training session.

All sessions are done via Skype, Facetime, ZOOM, etc., and can be booked as soon as you sign up below!

Pick the package that works best for you. After you make your purchase, one of Janis' team members will email you asap to book your 1st session!

Part 1. Basic information
Private Training Consultation Questionnaire
Full Name *

First Name Last Name
Gender

Male Female
Date of Birth *

Month Day Year
Age
years
Height
cm
Weight
KG
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?

none(seated only) Moderate (light activity such as walking) High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?

Rarely A few times a year A few times a month Weekly
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Medical and health information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?

Yes No
Has anyone of your immediate family developed heart disease before the age of 60?

Yes No
Do any diseases run in your family?

Yes No
Do you suffer from diabetes, asthma, high or low blood pressure?

Yes No
if yes please list:
Are you a current cigarette smoker?

Yes No
Your current diet could be best characterized as:

low-fat low-carb high-protein Vegetarian/Vegan No special diet
Part 4. Goals
Please rate your readiness for change.

1 2 3 4 5 6 7 8 9 10
What following goals does best fit in with your goals?

Improved health Improved endurance Increased strength Increased muscle mass Fat loss
What is your goal with your training?
Why?
TImeline for achieving your goal.

8 WKS 16 WKS 24 WKS 32 WKS 40 WKS 1 YEAR

NOW
How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.

1 2 3 4 5 6 7 8 9 10
Are you currently excersising regulary (at least 3x per week)?

Yes No
Have you trained with a personal trainer before?

Yes No
If yes what kind of training did you do:
At what times during the day would you prefer to train?

Morning Mid-Day Afternoon Evening
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
Please Read The Following Terms and Conditions.
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

*

2.) LATE ARRIVALS

Each session shall be 30 minutes to 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

*

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

*

4.) PERSONAL TRAINING CONTRACT/AGREEMENT

Congratulations on your decision to participate in an exercise program! With the help of your personal trainer, you greatly improve your ability to accomplish your training goals faster, safer, and with maximum benefits. The details of these training sessions can be used for a lifetime.

*

In order to maximize progress, it will be necessary for you to follow program guidelines during supervised and (if applicable) unsupervised training days. Remember, exercise and healthy eating are EQUALLY important!

*

During your exercise program, every effort will be made to assure your safety. However, as with any exercise program, there are risks, including increased heart stress and the chance of musculoskeletal injuries. In volunteering for this program, you agree to assume responsibility for these risks and waive any possibility for personal damage. You also agree that, to your knowledge, you have no limiting physical conditions or disability that would preclude an exercise program.

*

By signing below, you accept full responsibility for your own health and well-being AND you acknowledge an understanding that no responsibility is assumed by the leaders of the program. It is recommended that all program participants work with their personal trainer a minimum of two (2) times per week. However, due to scheduling conflicts and financial considerations, a combination of supervised and unsupervised workouts is possible.

*

5.) PERSONAL TRAINING TERMS & CONDITIONS

*

1. Client will promptly inform trainer of any change in medical condition or of any new injury.

2. Client agrees to allow Trainer to contact Client’s personal physician and/or obtain medical records when necessary.

3. Personal training sessions that are not rescheduled or canceled 24 hours in advance will result in forfeiture of the session and a loss of the financial investment at the rate of one session.

4. Clients arriving late will receive the remaining scheduled session time, unless other arrangements have been previously made with the trainer.

5. The expiration policy requires completion of all personal training sessions within 120 days from the date of the contract. Personal training sessions are void after this time period.

6. No personal training refunds will be issued for any reason, including but not limited to relocation, illness, and unused sessions.

*

6.) SCHEDULING AND FEES:

*

1. Training is paid in advance. Fees are non-refundable unless catastrophic injury or illness.

2. Once training is scheduled, both Client and Trainer are held liable for those time slots

3. If training is to continue beyond the initial session package, the new package sessions must be booked prior to “last appointment.”

4. At that time, another training session package will be reserved for client. Fees are due on first appointment of each new package.

5. Fees payable via paypal prior to 1st session of each package.

Fees: Fitness assessment is included with 10 - 1hr training session package booked

*

Fees subject to change with a 60 day notice

*

I declare that I have read, understand and agree to the contents of this Personal Training Agreement in its entirety. I understand that the Assumption of Risk, Waiver of Liability, and Personal Training Policies and Procedures are intended to be as broad and inclusive as permitted by the State of Florida in Dade County and agree that if any portion is held invalid, the remainder will continue in full force and effect.
I AGREE TO THE ABOVE TERMS & CONDITIONS! *

Yes No
Please choose your training plan

My Products

Fitness Assessment $ 150.00

30 Minute Private Training Session $ 75.00

1hr Private Training Session $ 125.00

10 - 1hr Private Training Sessions Package $ 1,000.00

Small Group Training Package $ 2,000.00

Total $ 0.00

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

BOOK YOUR SESSION

Part 1. Basic information

Private Training Consultation Questionnaire

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following Terms and Conditions.

Please choose your training plan