One-On-One Personal Training at Your Location

I am so glad you have decided to participate in Hooked on Fitness’ Personal Training Program and I am excited to join you as you take your health and fitness goals to the next level. I hope that your experience with me as your personal trainer will be a positive one and that it will motivate you to pursue a healthy lifestyle in all the aspects of wellness. I encourage you to commit to this “healthy lifestyle change” that will likely change your life!  Being healthy and taking care of our bodies is an important part of helping to prevent illness, disease, injuries and make us able to do everyday activities with more ease and enjoyment. It is also important to feel better each day as we allow our bodies to gain energy from being active!

RATES One-on-one Personal Training at your location:

30 Minute Session: $50.00 45 Minute Session: $60.00 60 Minute Session: $70.00 DISCOUNTS

I offer discounts for session packages. If you decide to train with more than one friend I offer discounts for group training for 3 or more clients. Ask me about these small group rates. Experience a motivational workout at a better deal with the enjoyment of a friend!

One-on-one Package Deals at your location: 30 Minute Sessions: 45 Minute Sessions: 60 Minute Sessions: 8 Sessions @ $350 8 Sessions @ $420 8 Sessions @ $490

NUTRITION I will put my effort into helping you out, but I deeply encourage you to make initiative to comply with my nutrition suggestions to help you achieve better results. Nutrition and exercise go hand in hand and are each essential parts of wellness.

STRETCHING Stretching will promote flexibility which will help you regain full range of motion and will assist in creating greater strength benefits. Flexibility will also help to prevent injuries to your tendons, joints and muscles. Flexibility is just as important to your body as all other aspects of fitness; it will improve your posture, and help you to have more ease with everyday activities. I encourage you to understand the benefits of the stretches I provide that will conclude each session. Stretching on a daily basis is highly recommended.

EXERCISE OUTSIDE YOUR TRAINING SESSIONS I put my full effort into designing each of your personal training sessions and encourage you to put in additional time training outside of our sessions.

THE IMPORTANCE OF CARDIO Cardio is an important part of an overall fitness plan. I recommend to those starting out do some sort of interval work for no longer than 20 minutes 2-3 days per week because:

-It keeps your metabolism revved for a longer period of time post workout. -Intervals are simply proven to be the most effective form of cardio -It won’t spike up your cortisol levels like longer cardio sessions. Pick a cardio machine or activity of choice and after warming up for about two minutes, move at a pace that would get you completely winded in 2 minutes tops. When you get to that point slow down the pace for 1-2 minutes and catch your breath then repeat 3-5 more times. If you’re not completely wiped out by the end it’s because you’re not pushing yourself hard enough during the sprint. That should do us for now. I greatly look forward to our first session and to working on your agenda for your health and fitness goals!

Michelle Pallozzi Hooked on Fitness www.HookedOnFitness.net [email protected] (215) 356-1976 Informed Consent & Assumption of Risk (Must be signed prior to beginning personal training sessions) ** Please read the following carefully. **

In connection with my enrollment in the exercise program and/or the use of the equipment and facilities used by Hooked on Fitness, I have read this document and understand it is a release of all claims. If I am engaging a personal trainer, I have read and understand the terms of the Personal Training Agreement.

I have been informed and acknowledge that Hooked on Fitness makes no claims as to medical results, which can or may be obtained through participation in this program, the use of the facilities and/or equipment.

I understand that Hooked on Fitness will not be responsible for suggesting nor providing any medical treatment to clients. Clients should rely only upon advice given by a licensed professional or their own physician and not by any unlicensed employee, agent or contractor of Hooked on Fitness. I consent to the administration of any immediate resuscitation measures deemed advisable by my trainer or other qualified personnel.

I represent that I have either (a) been given my physician’s permission to participate in fitness activity, or (b) decided to voluntarily participate in the program and have accepted voluntarily all risks related to the program without the approval of my physician. I represent that I am not aware of any medical or physical condition that would prevent me from participating in this program or from using equipment or facilities or would involve a serious health risk to me. I have informed, and agree to keep informed fully, Michelle Pallozzi of Hooked on Fitness of any physical medical condition or disability that would prevent or jeopardize my participation in this program or the use of equipment and facility.

I have been advised and understand that participation in the program and use of the equipment and facility presents some unavoidable risk of injury, especially to people who have preexisting injuries, illness or medical disabilities. I recognize that participation may cause short-term aggravation of some symptoms, feelings of tiredness, lightheadedness, increased energy, mood changes and other effects. I understand that I should stop exercising immediately if I detect any pain, dizziness or discomfort during the program. I agree to abide by all rules of Hooked on Fitness and agree to follow explicitly all instructions given during the course of my instruction. In consideration of being allowed to participate in the program or use the facilities and equipment, I (on behalf of my family, estate, heirs, or assigns) hereby waive, release, forever discharge and agree not to sue Hooked on Fitness, its employees, instructors, contractors from any and all claims, demands, damages, and causes of action, present or future, whether known or unknown, arising from my participation in this program or the use of the equipment or facilities, excepting only those claims, actions or damages directly caused by the willful or intentional acts of Hooked on Fitness. I affirm that I am of legal age or am a parent or adult guardian representing a minor and freely signing this agreement. I voluntarily sign my name evidencing my acceptance of these provisions.

Client’s Signature:______Date______Hooked on Fitness Representative Signature:______

Personal Training PAR-Q(Physical Activity Readiness Questionnaire) Thank you for your time in filling out the form truthfully and completely! I look forward to working together to accomplish your goals!This information is used solely as an aid. It will not be released without your knowledge and consent. Name ______Date______Birth Date______Address ______Street City State Zip Phone ______Email ______Physician Name ______Phone ______

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

2. Do you feel pain in your chest when you do physical activity?

3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you lose your balance because of dizziness or do you ever lose consciousness?

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by change in your physical activity?

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? If you checked “yes” for any question #1-#6, the “National Strength and Conditioning Association” states that you must receive clearance from your physician prior to participating in a progressive resistance exercise program. ______Initials

Past and Present Medical History Have you had or do you presently have any of the following conditions? (Check if yes.) ___ Rheumatic fever ___ Recent Surgery (Type ______) ___Edema (swelling in hands or feet) ___ High blood pressure ___ Injury to back or knees ___ Low blood pressure ___ Seizures ___ Lung disease ___ Heat attack ___ Fainting or dizziness ___ Diabetes ___ High cholesterol

___ Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden, unexpected attack of difficulty breathing) nocturnal dyspnea (shortness of breath at night) ___ Shortness of breath at rest or with mild exertion ___ Chest pains ___ Palpitations or tachycardia (unusually strong or rapid heartbeat) ___ Intermittent claudication (calf cramping) ___ Pain, discomfort in the chest, neck jaw, arms, or other areas ___ Known heart murmur ___ Unusual fatigue or shortness of breath with usual activities ___ Temporary loss of visual acuity or speech, or short-term numbness or weakness in one side, arm, or leg ___ Other (______) Family History Have any of your first-degree relatives (parent, sibling, or child) experienced the following conditions? (Check if yes.) In addition, please identify at what age the condition occurred. ___ Heart attack ___ Heat operation ___ Congenital heart disease ___ High blood pressure ___ High cholesterol ___ Diabetes ___ Other major illness (______) Explain checked items: (Continue on back if necessary) ______

Activity History 1. How were your referred to me? (Please be specific.) ______2. Why are you enrolling in Personal Training? (Please be specific.) ______3. Are you presently employed? Yes___ No___ 4. What is your present occupational position? ______5. Name of company: ______6. Have you ever worked with a personal trainer before? Yes___ No___ 7. Date of you last physical examination preformed by a physician: ______8. Do you participate in a regular exercise program at this time? Yes___ No___

ACTIVITY FREQUENCY TIME 9. Can you currently walk 4 miles briskly without fatigue? Yes___ No___

10. Have you ever performed resistance training exercises in the past? Yes___ No___ 11. Do you have injuries (bone or muscle disabilities) that may interfere with exercising? Yes___ No___ If yes, briefly describe: ______

12. Do you smoke? Yes__ No__ If yes, how much per day and what was your age when you started? Amount per day_____ Age_____

13. How high is the level of stress in your life? HIGH MODERATE LOW 14. What is your body weight now? ______What was it one year ago?______At age 21______

15. Do you consider yourself? _____ At my goal weight/body composition for maintenance _____ At a weight lower than optimal for health and fitness _____ At a weight higher than optimal for health and fitness

16. Do you follow or have you recently followed any specific dietary intake plan, and in general how do you feel about your nutritional habits? ______

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17. List the medications, nutritional supplements(s)/herbs, etc. you are presently taking:

18. Please list restaurants where you frequently eat and how often you eat out: ______

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Who usually prepares food in your household? ______

Where do you typically shop for groceries? ______19. List in order your personal health and fitness objectives. a. ______b. ______c. ______

*To be filled out together with your fitness professional: Goal Date Date Achieved

I have read this entire document and have answered all of the questions to the best of my knowledge. ______Client Name (print) Signature Date ______Trainer Name (print) Signature Date