Confirm Your Preferred Email
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Confirm you Preferred Phone
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Your age
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Your Birthday (Month and Day, e.g., April 4)
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Your height (feet, inches)
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What areas do you want to see changes in?
Check all that apply
If you wish to add more information on any of the items you choose in the last question, you can so here
Which option best describes your dietary/nutrition style?
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Omnivore - I eat both plant and animal sources of food
Vegetarian - I do not eat animal flesh/meat but I do consume animal-sourced foods like dairy and/or eggs
Vegan - I do not eat any animal products
Other - If you choose this option, you can describe in the next question below
Do you weigh yourself at home?
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Yes - at least weekly
Yes - at least monthly
Yes - but only a few times a year
No/only at the doctor's office
Other information about your dietary/nutrition approach
If the options provided for the previous question did not adequately capture your approach, use this field to explain/describe further.
Have in the past, or do you now, have challenges or difficulties with any of the following dynamics of nutrition?
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Please check all that apply
Have in the past, or do you now, have challenges or difficulties with any of the following dynamics of exercise/physical fitness?
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Please check all that apply
How do you best like to learn new information?
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Please check all that apply
Desired Evolving Outcome(s)
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What do you most want to see change, or develop, from our work together? Rather than 'goals,' think about changes in beliefs, thoughts, emotions, and behaviors that underpin or give life to evolving outcomes that you desire. There's no 'finish line' in this work to be healthier, stronger, fitter and more content in these things - so just think about the changes you want to begin experiencing as we work together - knowing these will continue to evolve - likely in ways you didn't expect! :-)
Do you currently journal/diary about anything in your life (fitness, nutrition, gratitude, memories, planning, etc.)?
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Yes - all the time/very consistently
Somewhat - I do but not consistently
No but interested - I haven't in the past, but would like to try
No - I don't like to journal/diary or track things
WEEKDAYS: What time blocks are you MOST ABLE AND WILLING to exercise on your own?
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These are times outside of those we identified for your personal training with me -- times you could do other exercise. Please check all that apply
WEEKENDS: What time blocks are you MOST ABLE AND WILLING to exercise on your own?
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These are times outside of those we identified for your personal training with me -- times you could do other exercise. Please check all that apply
Do you have any questions I can address and/or start to work with you on?
Please list/explain them here.
GROUP FITNESS AND PERSONAL TRAINING WAIVER
PLEASE READ CAREFULLY AND SELECT OPTION TO INDICATE UNDERSTANDING AND AGREEMENT:
I, the undersigned, hereby acknowledge and understand that participation in group fitness classes, personal training, and related activities conducted by Ground2Goal Fitness, LLC, Bonnie C. Ferenbach, hereafter referred to as ‘the Provider,’ involves certain risks and potential dangers. By signing this waiver, I voluntarily agree to assume all risks associated with my transit to and from the location of these services, my participation in any/all related fitness/training activities, and my overall activity while on the premises.
Assumption of Risk:
I acknowledge that I am voluntarily participating in the fitness and/or personal training activities provided by the Provider. I understand that physical exercise, by its very nature, carries with it certain inherent risks, including but not limited to physical injury, strain, discomfort, and even the possibility of serious injury or death. I hereby assume all risks and responsibility for any such injuries or other medical incidents.
Waiver and Release:
I hereby release, waive, discharge, and agree not to sue the Provider, its employees, representatives, affiliates, or agents from any claims, demands, liabilities, rights, damages, expenses, and causes of action of any nature arising out of or in connection with my participation in the fitness class(es), whether caused by the negligence of the Provider or otherwise.
Medical Representation:
I represent that I am physically fit to participate in the fitness class(es) and have no medical condition that would prevent my safe participation. If I have any medical conditions or concerns, I have consulted with a healthcare provider and obtained clearance to participate.
Consent to Medical Treatment:
I hereby consent to receive any necessary medical treatment resulting from my participation in the fitness class(es) and agree to bear all costs associated with such treatment.
Acknowledgment:
I have read this waiver in its entirety, and understand its contents, and agree to be bound by its terms.
I understand that I am giving up substantial legal rights by signing this document. I attest that my signature has not been coerced by any person, including but not limited to my agents/family/cohorts, or by any agent/cohort of Ground2Goal Fitness, LLC; I am electing my response below completely of my own choice and agency.
I understand and agree that the terms of this waiver apply from the date of submission of this form in perpetuity, and cover any and all events, activities and/or programming in which I engage with/through Ground2Goal Fitness, Bonnie Ferenbach, Owner/Principal.
I understand and agree with all terms of this waiver.
I understand and DO NOT agree with all terms of this waiver.
Digital Signature
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Please type your full/legal name here as a digital signature to confirm review of the liability waiver and indemnity information above.
