New Client Intake
Welcome. Please complete this intake so your trainer can review your information and prepare for your first session. Everything submitted here is private and used only to design a safe training program.
* Required
Your answers save on this device as you go, so you can stop and finish later. The signature is not saved.
What type of training are you inquiring about?
This determines which sections you'll need to complete.
Contact information
Who is completing this form? For adaptive clients, this is often a parent, guardian, or authorized representative.
Participant information
About the person who will be training.
One thing you want to be able to do
Tell us in your own words. Something specific that matters to you — like “walk to my mailbox without resting” or “lift my grandson without my back hurting.” This becomes your goal.
Health screening (PAR-Q+)
Answer YES or NO to each question. A YES to any question means your trainer will recommend getting physician clearance before starting.
Medical history
Part of your clinical screening. This — together with the PAR-Q+ above — is reviewed before training begins and informs any precautions or a physician-clearance recommendation. Share what's relevant; leave blank if it doesn't apply.
Nutrition profile (optional)
Used only if your trainer prepares nutrition targets for you. Skip if you don't want nutrition coaching.
Adaptive considerations
Helps your trainer design sessions that work with your communication style, sensory profile, and behavioral needs.
SDP & FMS details
Required for Regional Center billing. If you're unsure of any field, leave it blank — your trainer will follow up.
Anything else?
Check and sign
Check your answers, read the agreement, then sign.
Your answers
The agreement in short
Read the full agreement
Acknowledgment of risk & informed consent
I understand that personal training involves physical activity and carries inherent risks including but not limited to muscle soreness, joint strain, sprains, falls, and cardiovascular events. I have disclosed all known health conditions, injuries, medications, and physician restrictions truthfully in this intake form, and I understand that failing to disclose material health information is my responsibility.
I acknowledge that James Kennedy (KinetiqAF / James Kennedy & Associates LLC) is a NASM Certified Personal Trainer, Corrective Exercise Specialist, Certified Nutrition Coach, and Special Strong Certified Adaptive Trainer, not a physician. Nothing in our training replaces medical care, physical therapy, or clinical treatment.
Release & waiver
In consideration of being permitted to participate in personal training services provided by KinetiqAF, I hereby assume the inherent risks of physical exercise. I release, waive, and hold harmless James Kennedy & Associates LLC and its trainers from any claims arising from my participation, except for claims resulting from gross negligence.
Scope of services
- Fitness assessment, program design, and supervised training sessions.
- Nutrition coaching within the scope of ACE / NASM certification (general guidance, not a prescription diet or medical nutrition therapy).
- Progress tracking, communication via the client portal, and written session notes.
- For SDP / FMS clients: services documented per DDS Enclosure A requirements for Regional Center billing.
Cancellation & no-show policy
Cancellations made less than 24 hours in advance, and no-shows, may be charged at the full session rate at James's discretion. Recurring late cancellations may result in loss of your regular time slot.
Photo & video consent (optional — check box below)
From time to time, session photos or short videos may be useful for form correction review or progress marketing (with your name removed). You may consent or decline separately — your training is not conditional on this.
Privacy & data handling
Your health information is stored in KinetiqAF's private client database (Supabase), accessible only to James (and any authorized assistant trainers) as of the date you sign this form. It will never be sold or shared with third parties without your written consent, except as required by law, FMS billing, or Regional Center audit requirements.
Electronic signature
By typing my legal name and signing below, I acknowledge that I have read and understood this agreement, that my electronic signature carries the same legal weight as a handwritten signature under the U.S. ESIGN Act, and that I agree to its terms.
Photos