There are a few things you we will need from you in order to get you training with us as soon as possible. Please see the checklist below.

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1 Welcome to the 21 Day Trial at Blacksburg Fit Body Boot Camp! I am excited to welcome you to our fitness family and to learn more about your health and fitness journey. There are a few things you we will need from you in order to get you training with us as soon as possible. Please see the checklist below. Below is a PAR-Q, which is an overview of your current state of health, as well as an opportunity for you to share your goals and what you plan to accomplish over the next 21 days. Please bring this sheet to your first boot camp session. This sheet MUST be filled out in order for you to participate. As we all know, nutrition is 80% of weight loss, therefore we will be setting a Nutrition & Goal Setting Appointment (NAG) to provide any guidance needed in this area. Coach Christen will be your point of contact with your NAG appointment, however I need to know your availability for the 30-minute meeting that I can set between the two of you during week 2 of your 21-day trial. Please respond to this with that date. You will bring the New Client Consultation Form (below) filled out along with you to this meeting. All of our sessions have a 20-person cap; therefore, we require our members to register for class in advance. To do so we use Zenplanner, which is a website and application on your phone. If you are not currently enrolled in ZP please click the link below to create a profile. To do so simply click Sign up for a free class. We will then add the 21 days to your profile based on your start date. You will visit the online calendar via computer or your phone to reserve your spot for class each week. You may schedule your workouts up to 7 days in advance. Please cancel your reservation if you are unable to attend the class you reserved so that someone else may train. Start date: Please respond to this with the date that you would like to attend your first session. Take a before photo of yourself and save it in a safe place. At Blacksburg FBBC we are KNOWN for our amazing transformations and we do not want to miss out on capturing your journey. House Rules: To ensure safety and enjoyment for all of our members, there are a few house rules that we ask you to follow: 1. Please arrive to class at least 5 minutes early. You may not join class after the initial warm-up has started. 2. Bring a clean pair of shoes for class, not the same shoes that you walked into the facility wearing. 3. Check in upon arrival via the ipad on the front desk.

2 PHYSICAL ACTIVITY READINESS: Please answer all questions accurately and honestly to allow us to fully determine your individual needs. DATE LAST NAME FIRST NAME ADDRESS CITY STATE ZIP HOME PHONE BUS. PHONE AGE HEIGHT WEIGHT YES NO 1. Do you have high cholesterol? 2. Has your doctor ever said that you have heart trouble? 3. Has your doctor ever told you that you have a bone or joint problem (such as arthritis) that has been or may be exacerbated by physical activity? 4. Has your doctor ever told you that your blood pressure was too high? 5. Are you over 65 years of age and not accustomed to vigorous exercise? 6. Is there any reason, not mentioned thus far, that would not allow you to participate in a physical fitness program? The following information will be treated as privileged YES NO information: 1. Do you ever feel weak, fatigued, or sluggish? 2. How many meals do you eat each day? 3. Do you know how many calories you eat in a day? 4. Do you eat breakfast? 5. Are you taking supplements? (i.e. vitamins, amino acids, protein shakes, etc.) 6. Do you crave sugary foods? 7. Do you need several cups of coffee to keep you going

3 throughout the day? 8. Do you often experience digestive difficulties? 9. Proper nutrition can increase the body s ability to enhance physical and mental performance by up to 80%. Do you feel that a properly structured nutrition and exercise program would benefit you? 10. How long have you been exercising? 11. Have you reached and maintained your goals? 12. Are you happy with the way you look and your health? 13. On a scale of 1 to 10, how serious are you about achieving your goals? least most Please list your desired fitness goals: Desired Body Fat: Desired Waist Size: Desired Weight: Desired Dress or Pant Size: I plan to exercise times a week I am looking forward to getting fit and achieving results because when I do I ll finally be able to BUYER ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF Stahl Fitness, LLC dba Blacksburg Fit Body Boot Camp. BUYER ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER BUYER S PARTICIPATION IN THE PHYSICAL ACTIVITES. BUYER FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT AR NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BUYER, SLIP AND FALL BY BUYER, OR AN UNKNOWN HEALTH PROBLEM OF BUYER. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, BUYER AFFIRMS THAT BUYER IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYISCAL ACTIVITIES. BUYER ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND BUYER AGREES THAT IT IS THE RESPONSIBILITY OF BUYER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF BUYER TO TAKE PART IN <Stahl Fitness, LLC dba Blacksburg Fit Body Boot Camp> PHYSICAL ACTIVITIES. BY SIGNING THIS AGREEMENT, BUYER ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES. BUYER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS. INITIAL

4 NEW CLIENT CONSULTATION FORM Name: Date: Coach (Office Only): 1. Tell me a little bit about yourself and your fitness goals. 2. Why are your goals important to you? (drill down to emotion/problem) 3. How long did it take you to gain this weight? (drill down to severity of problem, how long it s been occurring, failed attempts to solve it, etc.) 4. In the past, how have you tried to get this weight off? (pause) And how many times have you tried? 5. Why do you think you ve failed so many times in the past? (really build problem here, it sets the stage for solidifying your value.) 6. Right now, how committed are you to achieving your goals, on a scale from 1 to 10? (get a 10 before moving on)

5 7. Transition: Ok, great! Let me just get a little more information from you 8. Tell me a little about your nutrition habits (meals per day, balanced diet). 9. What are your energy levels during the day? 10. How many times were you sick last year? 11. Are you taking any medication or supplements right now? If so, which ones and why? 12. Do you have any other additional health concerns or medical issues that I need to be aware of?