Gentle Strength Intake Form

I'm so excited to have you join a Gentle Strength program. We are going to have a lot of fun getting strong together! To help me support you through movement and programming variations, please answer the questions in this form to let me know a little more about any specific needs you may have. Please also ensure that you have agreed to the liability waiver and class policies.

First name

Last name

Preferred Pronouns

Address

Phone

Birthday

Emergency Contact Name and Phone Number

What has you physical activity looked like over the past year? Either formal excersize or lifestyle activities (walking, hiking, gardening, etc.)

If you have taken fitness classes or worked with a trainer in the past - What did you enjoy about that experience? What did you NOT enjoy?

Do you have any injuries or chronic conditions that may affect your training? Please explain with as much detail as possible.

Have you been diagnosed with low bone density? (Oestoperosis or Oesteopenia)

Yes

Have you had any surgeries in the past 5 years that could impact your training? If so, please explain.

Are you on any medications that could impact your training? If so, please explain.

Have you been pregnant or given birth in the past two years?

Yes

Do you experience any symptoms of decreased pelvic health? Such as: leaking with sneezing/laughing/jumping, heaviness in your pelvic area, general pelvic and/or hip pain and stiffness, etc.

Are there specific movements that you know will be especially challenging or out of reach for you currently? (For example, kneeling on the floor, bearing weight on wrists, balancing on one leg, lifting arms strait overhead, etc.)

Are there any accommodations that I can provide to make class sessions more comfortable and enjoyable for you? (sensory issues, music preferences, anything at all!)

Program Agreements

1. We are here to move our bodies out of love and respect in a safe and diet-culture-free zone. Avoid commenting on anyone's physical appearance, including your own. Avoid talking about diets and weight loss (your own dietary choices and goals are valid and personal, just be mindful of what you bring into the space and how it may impact others).

2. There is always a movement option that will work for you, and it is my job as a trainer to help you find it. If the options that I have demonstrated aren't feeling right, please practice speaking up and asking me for something different.

3. You control the intensity. This program is designed to meet people at a wide range of experience levels, which means that I will frequently include more challenging movement options and I will give everyone opportunities to push themselves to progressively add more load or volume as we move through the program. However, you always get to decide what you need and how much you want to push each day. I cannot know exactly how your body and mind are feeling. Trust yourself, rest as needed, and push through when you feel up to it. I will not question your decisions.

I have read and agree to the program agreements.

Liability Waiver

I, the undersigned, being fully aware of my own physical health and condition, and having clear knowledge that my participation in any exercise activity may be injurious to my health, am voluntarily participating in a physical exercise program created by Anne Schwalbe.

Having such knowledge, I hereby acknowledge and grant this release, and hold harmless Anne Schwalbe and representatives, agents, and successors from liability of accidental injury or illness that I may incur as a result of participating in the said physical exercise program. I hereby assume all risks in connection therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the said physical exercise program.

I have read and agree to the liability waiver.

I have read and agree to the missed class, refund, and other policies found here: https://www.gentlestrength.info/faq

I am vaccinated against COVID-19.

Signature