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					                                                     C N U FIT
                 Coaching Registration Form and Agreement
INSTRUCTIONS: Please completely fill-in the application to the best of your ability.
Please use additional paper if necessary. Fax or mail this form to C N U FIT for processing.
Upon receipt, your coach will be in contact with your to arrange for an initial consultation within 48 hours.

FAX:                     877-554-8106
ADDRESS:                 21 Saulsbury Rd Dover DE 19904
PHONE:                   302-689-3489


 Contact Information
Name:
Mobile: (            )                                         Home Phone: (         )
Address:
City:                                                          State:                                Zip:
Email:


 Personal Profile Information
   Male     Female DOB:                          Occupation:                             Avg. Hours Worked Per Week: _________
Children:                                      Ht:              Wt:              Body Fat %:                (if known)
Please Describe Your Personality




 Training Information
Describe your training program over the past 6 weeks (use additional paper if necessary): ________________________________




Have you been coached before? If so, please describe:



Do you have access to fitness equipment?                  Please Describe: ____________________________________________

List any group workouts you currently participate in:
What should your coach know about you in order to be most effective in coaching you?


                                                                                                                             1
                                                    C N U FIT
Coaching Information
Name the coach of your choice:                                         (leave blank if you’d like a coach assigned to you).
When do you wish to begin your program?


 Medical Information
Do you have any allergies?               If yes, please explain:


Do you take any medications that may affect your training?                   If yes, please explain:


Do you have any medical conditions or other injuries that your coach should be aware of when prescribing your training
plan?
      If yes, please explain: ___________________________________________________________________________________

Have you had a recent checkup from your doctor and have you been given the OK to participate in physical activity?
_______________________________________________________________________________________________


 CANCELLATION POLICY
Cancellation after Initial Consultation: If I cancel any time after the meeting for initial consultation, but within 3 business
days, I will be charged, one time, the coaching rate for my area. After the third business day, I will be responsible and
charged for the full 3 month agreement.

Cancellation After the 3 Month Session: Upon completion of my 3 month session, if I desire to cancel this Agreement, I am
to contact C N U FIT either by email, (cnufit4life@gmail.com), or in writing at least 10 calendar days prior to my next billing
cycle. These are the only acceptable forms of cancellation.

C N U FIT reserves the right to terminate services at any time. If C N U FIT terminates within the three month period, they
will refund paid wellness coaching services not performed at monthly rate agreed. __________

NO SHOW/RESCHEDULE POLICY
 If I need to cancel/reschedule an appointment, I will give at least 48hours notice. If I cancel/reschedule an appointment
 within 24-47 hours, I will be responsible for a $15 fee. If I do not show up for a session or do not give at least 24hours
 notice, I will be charged a $25 fee. This fee will be added to my monthly charges and will be deducted on my regular
 billing date with my standard charges. Cancellation/Reschedule fee may be waived at the discretion of CNU FIT (i.e.
 medical emergency, mandatory overtime, etc.)

 **Because we accept a limited number of reservations each week, we ask your assistance in informing us of
 cancellations as early as possible. This will allow us to offer your space to someone else.**



                                                                                                                                  2
                                              C N U FIT
I have read the above cancellation of program and no show/cancellation of appointment policies of CNU FIT. I
understand and agree to the above stated terms.

__________________________                                   _________________
 Client Signature                                                    Date


All recommendations are the property of C N U Fit and are subject to our terms. Recommendations are not to be
redistributed or shared in any way without the express written permission of C N U Fit. _____


PUNCTUALITY
I understand that appointments will begin and end promptly as scheduled. I acknowledge that any delays to the start of a
scheduled appointment will not be a cause of extend provided service beyond the remainder of the scheduled time. I will
not expect or ask my fitness coach to run overtime. I understand that sessions will run approximately one hour unless
otherwise stated. I acknowledge that a delay to a scheduled session cannot change the session status to anything else except
a whole session. _____




                                                                                                                          3
                                                    C N U FIT
  WAIVER
    There is inherent risk of injury while participating in physical training. I understand that physical training, the use of
    fitness equipment and services, and participation in this or other programs carries with it the potential for death or
    serious injury to occur. These risks include, but are not limited to (a) injuries arising from the use of any of the C N U
    FIT's equipment, including any accidental or slip-and-fall injuries; (b) injuries arising from participation in supervised
    or unsupervised activities and programs sponsored, recommended or endorsed by C N U FIT; (c) injuries or medical
    disorders resulting from exercise with fitness coach, including, but not limited to heart attacks, strokes, heart stress,
    sprains, broken bones, and torn muscles or ligaments; and (d) injuries resulting from the action taken or decisions
    made regarding medical or survival procedures. _________

     In of my participation in the Nutrition Counseling, I hereby accept all risk to my health and of my injury or death that
    may result from such participation and I hereby release the above named Institution, its governing board, officers,
    employees and representatives from any liability to me, my personal representatives, estate, heirs, next of kin, and
    assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or
    injury to my person, including my death, that may result from or occur during my participation in the Nutrition
    Counseling, whether caused by negligence of the Institution, its governing board, officers, employees, or
    representatives, or otherwise. I further agree to indemnify and hold harmless the Institution and its governing board,
    officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property
    that may result from my negligent or intentional act or omission while participating in the described Nutrition
    Counseling session. ______

    I understand and voluntarily accept these risks. I agree to specifically assume all risk of injury, whether physical or
    mental, as well as all risk of loss, theft or damage of personal property while I am participating in this or any other C
    N U FIT program, whether such programs take place inside or outside of a Fitness center. I waive any and all claims
    or actions that may arise against C N U FIT, its parent company affiliates, subsidiaries, successors, assigns,
    independent contractors and agents as well as each party, owner, director, employee, or volunteer as a result of any
    such injury, loss, theft or damage, including and without limitation, personal, bodily or mental injury, economic loss
    or any damage resulting from the negligence of C N U FIT, its parent companies, affiliates, subsidiaries, successors,
    assigns, agents, or independent contractors. If there is any claim by anyone based on any injury, loss, theft or damage
    that involves me, I agree to defend C N U FIT, its parent companies, affiliates, subsidiaries successors, assigns, agents
    and independent contractors against such claims. __________


  Release of Image and Likeness
    I hereby irrevocably consent to and grant C N U FIT, its subsidiaries, agents and representatives the exclusive and
    unlimited right to use and reproduce any and all photographs, audio recordings, video recordings or testimonial
    accounts taken by C N U FIT that contain my person, name, image, voice, likeness or account, for any lawful purpose
    whatsoever and using any means available, including but not limited to, any C N U FIT corporate or marketing
    communication or materials. I waive the right to inspect, approve or edit any such use or reproduction, and C N U FIT
    may make any and all changes, modifications, rearrangements, additions or deletions in its use or reproductions
    without any approval. I also understand and agree that I will not be compensated, in any way, for any such use of said
    materials. _______




X____________________________________________ ________________________________                       ______________
                 SIGNATURE                             PRINTED NAME                                        DATE




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                                                     C N U FIT
TERMS OF AGREEMENT (subject to change)
1. This COACHING PROGRAM has a minimum term of 3-months.
2. After the initial 3-months, you may cancel service whenever you wish. For your convenience, you will be
    billed automatically each month until we receive written notice of your desire to cancel.
3. There are no refunds.
4. You may suspend your service for a period of up to 3 months with written notice.
5. If you have any problems or concerns related to the quality of your service received from coach, you are to contact us
    immediately to address your concerns.
6. Our office may contact you shortly after we receive your order for coaching to obtain additional information
    pertinent to your coaching program including your goals, athletic background, training availability and more.
7. It is understood that your coaching contract is the property of C N U FIT.
8. You may contact our office with any billing or other administrative questions or concerns.
9. You card will be billed on the _____ of each month for wellness coaching.
10. All other services (i.e. nutritional products, workout sessions, workout equipment, and etc.) will be purchase and receipted
    separately.
11. If the payment is unable to be processed successfully on the billing date, there will be an additional charge of $25.
12. Partial Payments will not be accepted

I have read this Agreement thoroughly, understand all of its terms, received a copy, and have knowingly and voluntarily
signed it. IF PARTICIPANT IS UNDER 18 YEARS OF AGE: I, the undersigned parent or legal guardian of the
participant, hereby execute the foregoing for and on behalf of the participant.

X
                           Signature                                           Print Name                             Date

    PAYMENT & CONTRACT INFORMATION
Fitness Coaching Initial 3 months: One Time Payment $_______ or Month 1 $________ Month 2 $_______ Month 3 $_______

Monthly Rate of $          .00 will be billed after initial 3 months until services are cancelled.

CREDIT CARD:        Visa      AMEX        MC           Disc.                                                        Exp.        /

                                                                                                     CSC (found on back of card): _______
Name on Card:                                                   Billing Address:
City :                                                               State :                           Zip :


M ONTHY PAYMENT: I authorize C N U FIT to bill my credit card for monthly for coaching services during the
term of my contract. Any addition services will be agreed via an invoice.


Authorized Signature:                                                          Date:




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posted:3/30/2012
language:English
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