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I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in these exercise programs.
In consideration of my participation, I hereby release PHOENIX Fitness/Thom and The Pugs and its agents from any claims, demands or causes of action as a result of my voluntary participation and enrollment and I fully understand that I may injure myself as a result of my enrollment and subsequent participation in these programs.
I also release PHOENIX Fitness/Thom And The Pugs and its agents from any liability now or in the future for conditions, medical or otherwise, that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, injuries to knees, back or feet, or any other illness or soreness that I may incur , including death.
I HEREBY AFFIRM THAT I HAVE READ & FULLY UNDERSTAND THE ABOVE STATEMENTS. Name: _______________________ Date: ________
1 5915 Leewood Drive, Colorado Springs, CO 719-930-6365 | PHOENIX Fitness
REGISTRATION FORM Name: ________________________ Date: ____________ DOB: _________
Address: _________________________ City: ________________ State: _______ Best Number to Contact: ______________ Emergency Contact : ______________ Do you have any medical conditions ? YES ______ NO ________ Explain ___________________________________________________________ Do you have any allergies: YES ____ NO ________ Explain ____________________________________________________________ Are you taking any medications? YES _______ NO ________ Explain ____________________________________________________________ Do you have any physical ailments? YES ______ NO ______ Explain ____________________________________________________________ Do you experience aches or pains in any of these areas? Neck ____ Shoulders ____ Lower Back ____ Knees ____ Joints ____ Arms ____ Forearms/Wrists ____ Hips ____ Other Areas ___________
2 5915 Leewood Drive, Colorado Springs, CO 719-930-6365 | PHOENIX Fitness
WELLNESS EVALUATION Name ____________________ email: ___________________ Height _______ Weight __________ BMI ____________ 1. Do you eat more meals with poultry, lean meat, fish & plant (soy) proteins rather than steaks, roasts and other red meats? Y ___ N ___ 2. Do you eat at least 7 servings of various fruits & veggies per day? Y_______N ______ 3. Do you consume primarily whole grains (100% whole wheat bread, pasta, brown rice) rather than pasta, white rice and white bread? Y ____ N ______ 4. Do you eat ocean caught fish at least 3 times a week? Y _____ N _____ 5. Do you avoid fried foods, dressings, sauces, gravies, butter & margarine? Y___ N ___ 6. Is your digestive system free of indigestion or irregularity? Y ____ N ____ 7. Do you get at least 30 minutes exercise 3-5 days a week? Y ___ N _____ 8. Do you maintain a stable & appropriate weight? Y ____ N ___ 9. Do you usually prepare balanced meals, rather than eat take out or eating on the run? Y____ N _____ 10.Do you stay away from soda & typical snack foods throughout the day & after dinner? Y___ N ___ 11.Are you free of water retention & bloating? Y _____ N ______ 12.Do you have the energy & focus you need to meet your daily challenges? Y___ N ___ 13.Do you drink at least 8-8 oz glasses of water per day? Y ___ N _____ 14.What are your goals and objectives for working with a personal trainer? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
3 5915 Leewood Drive, Colorado Springs, CO 719-930-6365 | PHOENIX Fitness
BEFORE YOU USE FAR INFRA RED PRODUCTS READ THIS: DO NOT USE IF YOU HAVE CONSUMED ALCOHOL, PRESCRIPTION DRUGS OR BLOOD THINNERS WITHIN THE HOUR DO NOT USE THE SAUNA OR DO AN IONIC FOOT BATH IF YOU SUFFER FROM ANY OF THESE AILMENTS: PREGNANT OR NURSING KIDNEY DISEASE ANEMIA CANCER PACEMAKER EPILEPSY EATING DISORDER DIABETES AUTO IMMUNE TERMINAL ILLNESS ANY TYPES OF IMPLANTS
TIPS ABOUT FIR THERAPY
RATHER THAN HEATING JUST THE SURFACE OF THE SKIN, INFRARED HEAT PENETRATES AS FAR AS 2.3 INCHES UNDER THE SKIN TO REACH MUSCLES, BLOOD VESSELS, LYMPHATIC GLANDS AND NERVES. THE INCREASED CIRCULATION ALSO HELPS REGENERATE TISSUE, IE, TENDONS ASSOCIATED WITH TENNIS ELBOW FIR THERAPY HELPS CLEAR OUT TOXINS, SUCH AS LACTIC ACID WHICH CONTRIBUTES TO THE INFLAMMATION OF THE BODY FIR HEAT IMPROVES THE ABILITY OF COLLAGEN TO STRETCH. THIS IS ESPECIALLY VALUABLE WHEN TREATING LIGAMENTS, TENDONS AND OTHER SOFT TISSUE FOR RANGE OF MOTION PROBLEMS DO NOT USE THE AMETHYST CRYSTAL BIO MAT IF YOU ARE ON PRESCRIPTION MEDICATION, TETRACYCLINE, SULFA DRUGS, CHEMOTHERPAY AGENTS, ADDISON’S DISEASE, HEMOPHILIA, BLEEDING DISORDERS OR HYPERTENSION --PREGNANT WOMEN ARE ABLE TO USE THIS BUT ONLY ON LOW TEMPS, 2ND OR 3RD LIGHT I UNDERSTAND EVERYTHING I HAVE READ NAME: _____________________ DATE: ___________
4 5915 Leewood Drive, Colorado Springs, CO 719-930-6365 | PHOENIX Fitness