Self-Guided Program

Let's Get You Started

Complete the form below so we can build the right program for your goals. Takes about 5 minutes.

Info

Health

Goals

Lifestyle

Waiver

Section 01

Client Information

Full Name *

Date of Birth *

Gender *

Email Address *

Phone Number *

Emergency Contact Name *

Emergency Contact Phone *

Section 02

Health & Medical History

Do you have any medical conditions?

Are you currently taking any medications?

Do you have any allergies?

Have you had any surgeries or injuries in the past?

Do you have any current injuries affecting your training?

Section 04

Lifestyle & Training Preferences

Days per week you currently exercise

Typical daily activity level

Describe your typical diet

Any dietary restrictions or preferences?

Days & times available for training

Training format preference

1:1 In-Person Virtual / Online Small Group Self-Guided Program

How did you hear about us?

Anything else we should know?

Section 05

Waiver & Agreement

Waiver of Liability

I hereby release Tribe In Motion, LLC and any of its employees or contractors from any and all claims, liabilities and actions related to physical fitness, nutrition, rehabilitation and/or personal training that may be sustained by me during my association with said parties.

I understand that I am participating in personal training and nutrition, and that exercise has certain inherent risks and I enter into this program voluntarily.

24-Hour Cancellation Policy

Because your appointment time has been reserved especially for you, clients are required to give Tribe In Motion, LLC a minimum of 24 hours notice when canceling an appointment, which at that time can be rescheduled at no charge.

Sessions canceled with less than a 24-hour notice will be charged the full session rate.

Electronic Signature *

By typing your full name, you acknowledge this is your legally binding electronic signature.

Date *

I have read and agree to the Waiver of Liability and Cancellation Policy above.

✦

Welcome to the Tribe.

Your intake form has been submitted. Les will review your information and be in touch within 48 hours with your next steps and program details.