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.
ADDRESS: 21 Saulsbury Rd Dover DE 19904
Mobile: ( ) Home Phone: ( )
City: State: Zip:
Personal Profile Information
Male Female DOB: Occupation: Avg. Hours Worked Per Week: _________
Children: Ht: Wt: Body Fat %: (if known)
Please Describe Your Personality
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?
C N U FIT
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?
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
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 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, (email@example.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.**
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. _____
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. _____
C N U FIT
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
X____________________________________________ ________________________________ ______________
SIGNATURE PRINTED NAME DATE
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
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.
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: