THE ALIVE EXPERIENCE

Complete Client Intake Form

Health Questionnaire & Liability Waiver

Welcome to Your Transformation!

This comprehensive form includes both your health & goals questionnaire and our liability waiver.

Please complete all sections carefully. Your responses help us create the perfect training plan for you.

⏱️ Estimated time: 15-20 minutes

Basic Information

Emergency Contact

Current Health Status

No Stress Extremely Stressed

Fitness Background

Nutrition & Lifestyle

Goals & Motivation

Training Preferences

Program Interest & Budget

$500/month buy-in • Lose 10+ lbs = FREE training + $500 refund • Under 10 lbs = $50/lb shortage

LIABILITY WAIVER & RELEASE

PLEASE READ CAREFULLY BEFORE SIGNING

1. ASSUMPTION OF RISK

I understand and acknowledge that participation in fitness training and physical exercise carries inherent risks, including but not limited to:

  • Muscle strains, sprains, tears, and other soft tissue injuries
  • Bone fractures or stress fractures
  • Joint injuries or aggravation of pre-existing conditions
  • Cardiovascular events including abnormal blood pressure, heart attack, or stroke
  • Fainting, dizziness, or loss of consciousness
  • Heat exhaustion, heat stroke, or dehydration
  • Allergic reactions to supplements or nutritional recommendations
  • In rare instances, permanent disability or death

I hereby voluntarily assume all risks associated with my participation in training programs.

2. RELEASE OF LIABILITY

I HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE The Alive Experience, its owners, operators, trainers, employees, agents, contractors, and representatives from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or death that may be sustained by me during participation in training programs, whether caused by the negligence of the Released Parties, equipment malfunction, facility conditions, or any other cause whatsoever.

3. INDEMNIFICATION

I agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS the Released Parties from any and all claims, actions, damages, liabilities, costs, and expenses (including attorney's fees) arising out of or resulting from my participation in training programs.

4. MEDICAL CLEARANCE

I represent and warrant that I am physically and mentally capable of participating in fitness training. I have either:

  • Consulted with a licensed physician regarding my ability to participate in exercise programs, OR
  • Chosen to participate without physician clearance and accept full responsibility for this decision

5. NO MEDICAL OR PROFESSIONAL ADVICE

I understand that The Alive Experience is not a licensed medical provider and does not provide medical diagnosis, treatment, or advice. All fitness and nutritional guidance provided is for educational and motivational purposes only.

6. PAYMENT TERMS - "BET ON YOURSELF" CHALLENGE

If participating in the "Bet On Yourself" challenge, I understand and agree to:

  • Buy-in is $500 per month, paid in advance
  • If I lose 10 or more pounds in the designated month, my training is FREE and the $500 is refunded
  • If I lose under 10 pounds, I pay $50 per pound short of the 10-pound goal
  • Payment is due immediately upon monthly weigh-in completion
  • All weight measurements are final
  • No refunds for voluntary withdrawal

7. PHOTO/VIDEO RELEASE

I grant The Alive Experience permission to use photographs, videos, or testimonials featuring me for marketing and promotional purposes, unless I specifically opt out in writing.

IMPORTANT: This release extends to all claims of every kind and nature whatsoever, known or unknown, suspected or unsuspected, including claims for negligence, and covers both present and future claims.

Waiver Acknowledgment & Consent

Electronic Signature

ACKNOWLEDGMENT: I HAVE CAREFULLY READ THIS ENTIRE FORM AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT. I SIGN THIS VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

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✓ Intake Form Submitted Successfully!

Thank you for completing your health questionnaire and liability waiver.

We'll review your information and reach out within 24 hours to discuss your personalized training plan.

Get ready to transform your life!

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