Name
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First Name
Last Name
Date of Birth
*
MM
DD
YYYY
M/F
*
Male
Female
Email
*
Phone
(###)
###
####
City/State
Please choose the time of day you regularly workout.
Height
Weight
Physical Readiness Questions
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The information requested below helps us better understand your personal fitness goals and identify certain conditions that could affect your ability to participate in a workout. By providing answers to these questions, you acknowledge and agree that we may have such information kept on file at DAY 1 GYM.
Has your doctor ever told you that you have a:
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Heart Condition
Seizure Disorder
Dizziness/Fainting
Hypertension
Other (please specify)
None of the above
If other, please explain
Has a healthcare provider ever told you that you should not perform physical activity, or that you should only perform physical activity recommended by a doctor?
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Yes
No
Do you feel pain in your chest when participating in physical activity?
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Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
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Yes
No
Do you lose your balance because of dizziness, or do you ever lose consciousness?
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Yes
No
Do you have any muscle, tendon, ligament, bone, or joint problems that could be aggravated by a change in physical activity?
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Yes
No
Are you currently pregnant, planning to become pregnant, or recently postpartum?
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Yes
No
Are you currently taking any medications or supplements that may affect your heart rate or blood pressure?
Yes
No
Do you know of any other reason(s) why you should not do physical activity?
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Yes
No
IMPORTANT INFORMATION If you've answered YES to one or more Physical Activity Readiness questions above, DAY 1 recommends that BEFORE you participate in any DAY 1 wokrouts, you consult with your physician or healthcare provider to determine if it is safe for you to do so. If you've answered NO to all Physical Activity Readiness questions above, DAY 1 shall operate under the impression that you have done so with full knowledge of your physical readiness and ability to participate in DAY 1 workouts, including any coach-led, high-intensity interval workouts which DAY 1 provides. In the event your health status changes after you've consulted with your physician (or at any time during your DAY 1 membership), so that your answer to any of the Physical Activity Readiness questions becomes YES, please notify a staff member at the Studio before participation in any DAY 1 classes.
If you answered yes to any of the above, have you received guidance from your physician to change your exercise routine?
How did you hear about us?
Social Media
Website
Word of Mouth
Other
Share any specific goals we will help you achieve and why they are important to you: What have you been doing for fitness over the past 30-60 days to achieve your fitness goals?
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How long have you been thinking about achieving these goals?
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1-3 months
6-8 months
12+ months
What do you believe is missing from your routine?
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Additional Information
Select how committed are you about achieving your fitness goals?
What obstacles have you had in reaching your fitness goals and are they still present?
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Have you ever used personal training in the past and if Yes, how was your experience?
Yes
No
What were you doing at the time to be in the best shape of your life? And when was that?
Assumption of Risk, Release, Waiver of Liability, and Indemnification:
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We urge you and all clients to obtain a physical examination from a physician prior to initiating any exercise program. Day 1 Athletics LLC ("DAY 1") workouts are not designed for individuals with known heart disease with or without functional impairment. You understand and agree that there Is a risk of Injury associated with participation in any exercise program and that there exists the possibility for certain conditions occurring during or following training and/or exercise. In recognition of the possible dangers connected with any physical activity, by signing below, you understand, acknowledge, agree, and hereby voluntarily accept all risk and responsibility associated with the services provided and use of any of the facilities at any DAY 1. You
acknowledge that is your responsibility to disclose any medical condition or medication that could affect or prevent you from performing physical activity. You acknowledge that we may require you to provide written physician approval before you may use or participate in any physical activity at the Day 1. You acknowledge that you may decrease or stop at any time any physical activity you perform at DAY 1 and that it is your obligation to inform DAY 1's staff of any medical symptoms or Issues that arise while at DAY 1. You hereby waive all claims, assume all liability, and release, hold harmless, indemnify, and agree to defend us, Day 1 Athletics LLC, the entity who granted us contractual authority to independently own and operate our location, and any other DAY 1 studios, any owner of any other DAY 1 studio you may visit, and any of our or their respective affiliates, successors, assigns, agents, representatives, and employees, from liability for any injury, claim, cause of action, suit, demand, and damages (including, without limitation, personal, bodily, or mental injury, property damage, economic loss, consequential damages, and punitive damages), arising from or related to (1) your failure to disclose any pre-existing conditions, limitations, or sensitivities; (2) your presence on the premises of any DAY 1; (3) your participation in any DAY 1 workouts or use of any equipment at any DAY 1 GYM ; and/or (4) any negligence on our part (including our employees) or on the part of any employee at any other DAY 1 GYM. You further expressly agree that this Assumption of Risk, Release, Waiver of Liability, and Indemnification is intended to be as broad and inclusive as permitted by law, that you are aware of Section 1542 of the California Civil Code, and that you expressly agree to waive the protections, rights, and benefits you may have under Section 1542 relating to this Assumption of Risk, Release, Waiver of Liability, and Indemnification. Section 1542 states: "A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME DAY 1 EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR." You expressly agree that if any portion of this Assumption of Risk, Release, Waiver of Liability, and Indemnification is held invalid, the balance shall be valid and continue in full legal force and effect. These provisions are binding on you, your estate, family, heirs, administrators, personal representatives, and assigns.
Use of Personal Information, Image, Likeness, and/or Voice: We may photograph, record on audio or video, or otherwise record DAY 1 classes or client use of the Studio. In exchange for your use of the Studio or your participation in any DAY 1 worokout, you understand, acknowledge, and agree that you may be photographed, recorded on audio or video, or otherwise recorded while at the DAY 1 GYM, and hereby agree and consent for all purposes to the sale, reproduction, and/or use in any manner of any such photograph, audio, video, or other recording or depiction of your likeness and for voice whatsoever by us, Day 1 Athletics LLC, and any nominee or designee of us or them, including without limitation any agency, client, periodical or other publication, in all forms of media, whether now or hereafter devised, throughout the world and in perpetuity, and in all manners, Including without limitation advertising, trade, display, editorial, art and exhibition. You further understand and agree that any such photograph, audio, video, or other recording or depiction of your likeness and for voice may be modified, altered, cropped and combined with other content such as Images, video, audio, text and graphics, and hereby waive any right that you may have to Inspect or approve any finished Image, video, or audio containing a depiction of your likeness or voice. You further agree that the DAY 1 GYM, any other DAY 1 studio, may use any information gathered in this form or through your use of the DAY 1 GYM or participation in any DAY 1 workouts, provided the information does not personally identify you or provide facts that could lead to your identification, for any purpose, including without limitation research, product and program improvements, and statistical purposes. You agree to hold harmless and indemnify the DAY 1 GYM, any other DAY 1 studio, from and against any and all liability, damage, loss and/or claims of any kind or nature whatsoever, including, without limitation, any and all claims and demands relating to libel, invasion of privacy, and violation of publicity rights.
Authorization for Phone Calls and Text Messages: By providing your phone number above and signing below, you consent to and authorize the Day 1 Athletics LLC, and/or their agents to call or send you text messages to the number you provide regarding
(1) class reminders, waitlists, account balances, and/or transactions, and (2) DAY 1 promotions or advertising. You acknowledge that these calls or text messages may be sent via auto dialer, and that standard message and data rates may apply. You are not required to authorize calls or text messages to become an DAY 1 member, and you may opt-out at any time by request if called or by replying "STOP" in response to a message.
You acknowledge and agree that neither Day 1 Athletics LLC, nor any of DAY 1’s past, present, or future subsidiaries, successors, assigns, or affiliates, or their respective officers, directors, incorporators, members, partners, owners, agents, management, controlling parties, entities under common control, vendors, service providers, investors, attorneys, employees, or representatives is a party to this agreement. You understand and agree that the Day 1 Athletics LLC and affiliates are not responsible for any acts or omissions related in any way to this agreement, the goods or services provided to you hereunder, or for any act or omission by us or any other DAY 1 GYM or any employee, agent or representative of any DAY 1 Athletics LLC.
Emergency Contact
*
First Name
Last Name
Emergency Contact #
(###)
###
####
Select a Start Date
MM
DD
YYYY
