TSG – Program Design Only Signup Program Design Only Program Design Only Liability Release, PAR-Q and Questionnaire 1 2 3 4 5 Name* First Last Email* Did you already submit a signup form?*NoYesIf you already submitted a signup form, there is no need to fill out another one. Someone from billing@thestrengthguys.com will contact you to answer any questions you may have and assist with our payment process. You can just exit the form now unless you really want to fill out a second version of it.Are you full time student?*YesNoMasters or PhD StudentWe have just launched our new Strength Scholars program. The TSG Strength Scholars Program rewards academic performance at the end of each semester with up to a 15% reimbursement on coaching fees. If you are a full time student, please let us know and we'll tell you about this program.The Strength Guys Inc. Upon accepting this Client Agreement and payment of the Service Fees, you will be deemed to have automatically accepted this Client Agreement and all the terms and conditions set forth herein. If you wish to decline this Agreement or any term or condition, you must exit online form. No refunds issued after receiving initial training program and/or nutrition manual. The Strength Guys Inc. Service Providers: Jason Tremblay, Alfred Jong, John Downing, Taylor Atwood, Brandon Roberts, Kedric Kwan, Ben Esgro, Chad Dolan, Ryan Smith, Nicola Paviglianiti, Ericka Smith and Anthony Walker 1. LIABILITY RELEASE The Client hereby releases, indemnify, and hold harmless, the Service Providers from any and all manner of actions, causes of action, suits, proceeding, debts, dues, contracts, judgments, damages, claims and demands whatsoever in law or equity stemming from the agreement between the below mentioned parties. Client expressly agrees that this release, waiver, and indemnity clause is intended to be as broad and inclusive, and if any portion thereof is held invalid, it is agreed the balance shall, notwithstanding, continue in full legal force and effect. I have no known physical or mental condition that would impair my capability to participate fully, as intended or expected of me. I have carefully read the foregoing release and indemnification clause and understand the contents thereof. I fully understand the risks of participating in physical activity and agree that the Service Providers shall not be held liable in the case of any training related injury or death. 2. GENERAL PROVISIONS CLIENT acknowledges before beginning, implementing, or using any and all of recommendations provided, that CLIENT should consult a medical doctor. CLIENT acknowledges that client is not authorizing to disseminate, share, convey, or transfer any recommendation, either orally or written, provided by the Service Provider without his express written consent. It is the responsibility of the athlete to adhere to their plans and promptly inform your coach and Jason@thestrengthguys.com if issues or concerns arise. In consideration of the above referenced release, the named parties have agreed to the following terms: CLIENT will receive the following services: 1. Four week training program per month 2. Monthly consultation with coach The Strength Guys Inc. will provide the following services: 1 Four week training program per month including planned progression monthly 2 Monthly client consultation In exchange for listed price+ GST (GST applicable to residents of Canada only) . Client may cancel at anytime. Please note as The Strength Guys Inc. is an online coaching company, phone calls or Skype calls are not included in standard service offering. If you would like to arrange a call with your coach, please discuss with him or her directly. There may be an additional charge depending on nature of request. To qualify for discounted package prices, you will be asked to pay for first and last month upfront (no refunds).Accept Liability Terms and Conditions*ACCEPTTo DECLINE, please exit form. If you would like further information, please email billing@thestrengthguys.com .By submitting this agreement, I hereby agree that I will not take any substance on the current WADA prohibited list unless I have a Therapeutic Use Exemption (TUE). Failure to comply will result in termination of the contract with no refund. CONFIRMATION*CONFIRMED I am NOT using a prohibited substanceI am using one of the listed substancesIf you would like further information, please email billing@thestrengthguys.com . If you are using a prohibited substance, we will contact you asking for details. 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*YesNo2. Do you feel pain in your chest when you do physical activity?*YesNo3. In the past month, have you had chest pain when you were not doing physical activity?*YesNo4. Do you lose your balance because of dizziness or do you ever lose consciousness?*YesNo5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*YesNo6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*YesNo7. Do you know of any other reason why you should not do physical activity?*YesNo Gender*MaleFemaleAge*Height*4'8"4'9"5'5'1"5'2"5'3"5'4"5'5"5'6"5'7"5'8"5'9"5'10"5'11"6'6'1"6'2"6'3"6'4"6'5"6'6"6'7"6'8"6'9"6'10"6'11"7'Weight*100 lbs102 lbs104 lbs106 lbs108 lbs110 lbs112 lbs114 lbs116 lbs118 lbs120 lbs122 lbs124 lbs126 lbs128 lbs130 lbs132 lbs134 lbs136 lbs138 lbs140 lbs142 lbs144 lbs146 lbs148 lbs150 lbs152 lbs154 lbs156 lbs158 lbs160 lbs162 lbs164 lbs166 lbs168 lbs170 lbs172 lbs174 lbs176 lbs178 lbs180 lbs182 lbs184 lbs186 lbs188 lbs190 lbs192 lbs194 lbs196 lbs198 lbs200 lbs202 lbs204 lbs206 lbs208 lbs210 lbs212 lbs214 lbs216 lbs218 lbs220 lbs222 lbs224 lbs226 lbs228 lbs230 lbs232 lbs234 lbs236 lbs238 lbs240 lbs242 lbs244 lbs246 lbs248 lbs250 lbs252 lbs254 lbs256 lbs258 lbs260 lbs262 lbs264 lbs266 lbs268 lbs270 lbs272 lbs274 lbs276 lbs278 lbs280 lbs282 lbs284 lbs286 lbs288 lbs290 lbs292 lbs294 lbs296 lbs298 lbs300 lbs300+ lbsWaist MeasurementMeasure circumference of waist around belly button (in. or cm)Have you already been chatting with one of our coaches?NoYesWe'd like to know so we can ensure you get to work with that coach. If you don't mention that you have been in contact with a coach already, we will assign a coach for you.Coach name*Did someone refer you?NoYesName of person who referred youHow did you hear about us?What avenue do you best identify with?*BodybuildingPowerliftingFigureBikiniPhysiqueWeight LossGeneral Strength TrainingGeneral Physique DevelopmentBriefly describe your medical history as it relates to training and nutritionInjuries, eating disorders, medical conditions etc TrainingHow long have been resistance training?*< 6 months6 months - 1 year1 - 2 years2 - 4 years4+ yearsHow many days per week on average are you currently resistance training?*01234567How many days per week are you available for training?*01234567How many hours per day are you able to train?*30 minutes1234+Current Squat 1RM*If you don't have a one rep max, give us an idea of your current strength (lbs or kg's)How many times per week are you performing the Back Squat?*Current Bench Press 1RM*If you don't have a one rep max, give us an idea of your current strength (lbs or kg's)How many times per week are you performing Bench Press?*Current Deadlift 1RM*If you don't have a one rep max, give us an idea of your current strength (lbs or kg's)How many times per week are you performing the Deadlift?*Are you preparing for a specific meet or competition?NoYesMaybePlease provide competition name and date.Describe your current training program*(ie. exercise type, rep ranges, sets per exercise, frequency etc)Are there any exercises you are unable to perform due to injury?List 3 of your favorite exercises.*Are there any exercises you would like to avoid?Describe your current conditioning program(ie. exercise type, frequency, duration, intensity)Briefly describe your goals for your consultation with your coach* Do you live in Canada?*YesNoCountry*Programming Only* Price: $115.00 Programming Only - Canadian Residents Price: $145.00 $145 CAD + GST Someone will contact you from billing@thestrengthguys.com to setup your payments in Canadian dollarsDo you have further questions?Someone will contact you from billing@thestrengthguys.com to answer any questions you may have.
