Welcome in. Let's start with you.

This is the only paperwork you'll do with me. It tells me where your body is today, where you want it to go, and how to train you safely, in the studio or online.

10 MINSix steps: you, your goals, your health, your lifestyle, how we'll train, and your consent.

PRIVATEYour health answers are seen only by your coach and kept confidential.

NEXTI'll read it before session one and bring a plan built around it.

Strength · Mobility · Breath · Toronto

Step one

About you

Full name of the person training *

Date of birth *

Phone *

Email *

City / postal code

Occupation, and how much of your day is spent sitting?

Emergency contact

Only used if something happens during a session.

Name and relationship to you *

Their phone *

Step two

What you're training for

Your main goal, in your own words

Target date

Training consistently for

Sessions per week right now

0 1–2 3–4 5+

What's driving this goal?

What has gotten in the way before?

Step three

Health history

Based on the PAR-Q+ health screening. Please answer honestly. A yes doesn't stop you training; it just changes how we start.

A few more health questions

Your doctor

Family doctor's name

Their phone

Your medical history: tap anything you have now or have had

Any other diagnosed conditions, and when they were diagnosed

Medications you take: name, dose and what it's for

Allergies (medications, food, latex, etc.)

Family history: has a blood relative (parent, sibling, grandparent) had any of these?

Who in your family, and which condition?

Where do you have pain, now or in the past?

Tell me about any injuries, surgeries or pain areas: what happened, when, and what aggravates it

Step four

Lifestyle & recovery

No judgement here. This helps me plan training and recovery around your real life.

Sleep per night, on average

Under 5 hrs5–7 hrs8–10 hrs10+ hrs

Your energy on most days

LowModerateHigh

Water per day

Which best describes your work and exercise habits?

Are you used to vigorous exercise?

YesNo

Do you work more than 40 hours a week?

YesNo

Are you on a specific eating plan? If so, who prescribed it?

Any recent weight gain or loss? How much, and over what time?

How would you describe your current eating habits, including how you fuel around training?

Step five

How we'll train

Where will most sessions happen?

In studio Online Both

Equipment you can get to

Open to hands-on assisted stretching in session?

YesNo

Want a short breathwork practice included?

YesNo

Training facility or gym (if known)

Is anyone supporting you in your goals? Who?

What kind of accountability works for you, and how do you handle low-motivation days?

Anything else you'd like me to know?

Step six

Consent & agreement

Please read each section and tick to confirm. This protects you and me, and it's standard for personal training.

1. Informed consent & assumption of risk

I understand that personal training, including strength training, conditioning, mobility work, assisted stretching and breathwork, involves physical exertion and carries inherent risks, both known and unknown. These include muscle soreness, strains, sprains, falls, joint or back injury, dizziness and, in rare cases, serious injury, heart attack or death. I am taking part voluntarily, I may stop or modify any exercise at any time, and I accept these risks.

I understand and accept the risks of training.

2. Release of liability

To the fullest extent permitted by the laws of Ontario, I release Jessica Sturrup, JSA Performance, and the facilities where my sessions take place, from any claims for injury, illness, loss or damage arising from my participation in training, including from the inherent risks described above. I have read this release and understand that I am giving up certain legal rights by agreeing to it.

I have read and agree to the release of liability.

3. Scope of services

JSA Performance provides fitness coaching, exercise programming, corrective exercise, general nutrition guidance, assisted stretching and breathwork. This is not medical care, physiotherapy, diagnosis or treatment, and it does not replace advice from my doctor or other health professional.

I understand my coach does not provide medical advice.

4. My responsibilities

My answers on this form are true and complete to the best of my knowledge, and I have told my coach about any condition or physical limitation that could be aggravated by exercise.
To the best of my knowledge, I am in suitable health to take part. It is my responsibility to consult a physician before starting, and during training, about any health concerns.
If I answered yes to any health question, I'll get clearance from my doctor before starting.
I'll tell my coach right away about any change in my health, injuries, medications, pain or pregnancy.
I'll stop and tell my coach immediately if I feel pain, dizziness, chest discomfort or unusual shortness of breath.
I'll show up honestly and consistently, and follow the guidance given to the best of my ability.

I agree to these responsibilities.

5. Emergency care

If I need urgent medical attention during a session, I authorize my coach to call emergency services and contact my emergency contact. I am responsible for any costs of that care.

I authorize emergency care if needed.

6. Privacy

My information is collected only to plan and deliver safe, effective training. It's kept confidential and won't be shared without my consent, except in an emergency or where required by law. I can ask to see, correct or delete my information at any time by emailing info@jsaperformance.com.

I consent to the collection and use of my information as described.

7. Policies

I agree to give at least 24 hours' notice to cancel or reschedule a session. Sessions cancelled with less than 24 hours' notice, or missed without notice, may be charged in full.

I agree to the 24-hour cancellation policy.

8. Photos & video (optional)

May JSA Performance use photos or videos of my training on its website and social media? I can change my mind at any time.

Yes Without my face No

Is the person training under 18? *

No Yes

Because the participant is under 18, a parent or legal guardian must complete the signature below and agrees to all sections above on the participant's behalf.

Parent / guardian full name *

Relationship *

Parent / guardian phone *

I've read and understand everything above, and confirm my answers are accurate. I am legally competent to sign (18 or older, or the participant's parent or guardian), I am signing voluntarily, and I understand that typing my name below is my electronic signature.

Type your full name to sign *

Date *

Questions? Email info@jsaperformance.com

That's everything. Thank you.

Your intake is with your coach. Within 24 hours you'll hear from me about your first session: what to wear, what to bring, and where to be.

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